Healthcare Provider Details

I. General information

NPI: 1093806705
Provider Name (Legal Business Name): ENT ASSOCIATES OF WESTERLY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WELLS ST STE. 201
WESTERLY RI
02891-2923
US

IV. Provider business mailing address

17 WELLS ST STE. 201
WESTERLY RI
02891-2923
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2033
  • Fax: 401-596-9294
Mailing address:
  • Phone: 401-596-2033
  • Fax: 401-596-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY FELDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 401-596-2033