Healthcare Provider Details

I. General information

NPI: 1124079769
Provider Name (Legal Business Name): EAR, NOSE & THROAT ASSOCIATES OF NEW YORK,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16303 HORACE HARDING EXPY LOWR LEVEL
FRESH MEADOWS NY
11365-1454
US

IV. Provider business mailing address

5528 MAIN ST
FLUSHING NY
11355-5044
US

V. Phone/Fax

Practice location:
  • Phone: 718-445-5100
  • Fax: 718-886-7466
Mailing address:
  • Phone: 718-445-5100
  • Fax: 718-886-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LYNN JONES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 440-684-8871