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General NPI Number Information
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NPI Number | 1457315715
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OTOLARYNGOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 205 N BROAD ST SUITE 401
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1554
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Country | US
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Telephone | 215-762-4600
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Fax | 215-988-0733
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Provider Business Mailing Address
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Address Line | 205 N BROAD ST SUITE 401
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1554
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Country | US
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Telephone | 215-762-4600
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Fax | 215-988-0733
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW JOEL NAGORSKY
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Credential | MD
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Telephone | 215-762-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State |
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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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