Healthcare Provider Details

I. General information

NPI: 1770213340
Provider Name (Legal Business Name): NORTHEASTERN NEW JERSEY ENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1 DEGRAW AVE
TEANECK NJ
07666-4000
US

IV. Provider business mailing address

46 N CENTRAL AVE
RAMSEY NJ
07446-1864
US

V. Phone/Fax

Practice location:
  • Phone: 201-837-2174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL LEHRER
Title or Position: OWNER
Credential: MD
Phone: 201-837-2174