Healthcare Provider Details

I. General information

NPI: 1417188004
Provider Name (Legal Business Name): NORTHEAST ENT SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18929 HIGHWAY 59 N
HUMBLE TX
77338-4270
US

IV. Provider business mailing address

PO BOX 669
HUMBLE TX
77347-0669
US

V. Phone/Fax

Practice location:
  • Phone: 281-446-4053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number007917
License Number StateTX

VIII. Authorized Official

Name: MAJED IBRAHIM I
Title or Position: PRESIDENT
Credential: M.D
Phone: 713-621-2556