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General NPI Number Information
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NPI Number | 1295703437
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Entity Type | Organization
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Legal Business Name | EAR,NOSE AND THROAT SPECIALISTS,PC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 1206 W SHERMAN AVE STE 2B
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City | VINELAND
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State | NJ
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Zip | 08360-6911
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Country | US
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Telephone | 856-696-5510
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Fax | 856-696-5590
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Provider Business Mailing Address
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Address Line | 1206 W SHERMAN AVE SUITE B2
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City | VINELAND
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State | NJ
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Zip | 08360-6916
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Country | US
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Telephone | 856-696-5510
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Fax | 856-696-5590
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RODOLFO DIAZ
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Credential | M.D.
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Telephone | 856-696-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA04900200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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