Healthcare Provider Details

I. General information

NPI: 1396892402
Provider Name (Legal Business Name): NORTHERN JERSEY EAR, NOSE & THROAT ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GODWIN AVENUE
MIDLAND PARK NJ
07432
US

IV. Provider business mailing address

1 DEGRAW AVENUE
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2900
  • Fax: 201-445-8679
Mailing address:
  • Phone: 201-837-2174
  • Fax: 201-836-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JENNIFER SEYMOUR
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 201-837-2174