Healthcare Provider Details

I. General information

NPI: 1497137491
Provider Name (Legal Business Name): FIRST STATE ENT ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA ROAD NEUROSCIENCE BUILDING STE B4
NEWARK DE
19713-4236
US

IV. Provider business mailing address

774 CHRISTIANA ROAD NEUROSCIENCE BUILDING STE B4
NEWARK DE
19713-4236
US

V. Phone/Fax

Practice location:
  • Phone: 302-266-2449
  • Fax: 302-266-2450
Mailing address:
  • Phone: 302-266-2449
  • Fax: 302-266-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC10008440
License Number StateDE

VIII. Authorized Official

Name: DR. JAGDEEP S HUNDAL
Title or Position: OWNER
Credential: M.D.
Phone: 302-266-9166