Healthcare Provider Details

I. General information

NPI: 1598769259
Provider Name (Legal Business Name): SEAN D. HOUSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ROUTE 33 SUITE 101
NEPTUNE NJ
07753
US

IV. Provider business mailing address

3700 ROUTE 33 SUITE 101
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-7855
  • Fax: 732-280-7815
Mailing address:
  • Phone: 732-280-7855
  • Fax: 732-280-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMA72979
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: