Healthcare Provider Details

I. General information

NPI: 1033167671
Provider Name (Legal Business Name): EAR NOSE THROAT AND FACIAL PLASTIC SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 ROUTE 88 SUITE 240
BRICK NJ
08724-3009
US

IV. Provider business mailing address

PO BOX 95000-8277
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-8575
  • Fax: 732-206-0578
Mailing address:
  • Phone: 732-807-0800
  • Fax: 732-922-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES CLARKE
Title or Position: EXECUTIVE VICE PRESIDENT, PHYSICIAN
Credential: M.D.
Phone: 732-765-6317