Healthcare Provider Details

I. General information

NPI: 1104910876
Provider Name (Legal Business Name): ENT FACULTY PRACTICE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAW MILL RIVER RD SUITE 101
ARDSLEY NY
10502-1045
US

IV. Provider business mailing address

PO BOX 708
ARDSLEY NY
10502-0708
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-7636
  • Fax: 914-886-0027
Mailing address:
  • Phone: 914-886-0024
  • Fax: 914-886-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTINE MOSCATELLO
Title or Position: PARTNER
Credential: MD
Phone: 914-693-7636