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General NPI Number Information
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NPI Number | 1982695979
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Entity Type | Organization
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Legal Business Name | EAR, NOSE & THROAT ASSOCIATES OF WATERBURY, PC
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 171 GRANDVIEW AVE 201
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City | WATERBURY
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State | CT
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Zip | 06708-2517
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Country | US
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Telephone | 203-753-8833
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Fax | 203-346-6977
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Provider Business Mailing Address
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Address Line | 171 GRANDVIEW AVE 201
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City | WATERBURY
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State | CT
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Zip | 06708-2517
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Country | US
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Telephone | 203-753-8833
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Fax | 203-346-6977
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | VICTOR M GOTAY
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Credential | MD
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Telephone | 203-753-8833
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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 |
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License Number State |
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