Healthcare Provider Details

I. General information

NPI: 1386685881
Provider Name (Legal Business Name): EAR, NOSE & THROAT SURGEONS OF WESTERN NEW ENGLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASON AVENUE SUITE 100
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

100 WASON AVENUE SUITE 100
SPRINGFIELD MA
01107
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-7426
  • Fax: 713-734-2371
Mailing address:
  • Phone: 413-732-7426
  • Fax: 713-734-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY R JACOBS
Title or Position: PRESIDENT
Credential: MD
Phone: 413-732-7426