Healthcare Provider Details

I. General information

NPI: 1710554217
Provider Name (Legal Business Name): MASSACHUSETTS EAR NOSE AND THROAT ASSOCIATES 4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UNICORN PARK DR STE 102
WOBURN MA
01801-3379
US

IV. Provider business mailing address

321 BILLERICA RD STE 202
CHELMSFORD MA
01824-4100
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-5557
  • Fax: 978-256-1835
Mailing address:
  • Phone: 978-256-5557
  • Fax: 978-256-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VIJAY NAYAK
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 978-256-5557