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General NPI Number Information
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NPI Number | 1548577059
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Entity Type | Organization
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Legal Business Name | INNOVATIVE OTOLARYNGOLOGY, P.C.
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 775 PARK AVE STE 225
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City | HUNTINGTON
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State | NY
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Zip | 11743-7532
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Country | US
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Telephone | 631-923-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 775 PARK AVE STE 225
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City | HUNTINGTON
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State | NY
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Zip | 11743-7532
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Country | US
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Telephone | 631-923-1900
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOSHUA ROSENTHAL
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Credential | M.D.
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Telephone | 631-923-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 235220
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License Number State | NY
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