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NPI Code Detail

MEDICARE: EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC

MEDICARE: EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790854651
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC
Provider Business Mailing Address
First Line : 31 BROADWAY
Second Line :
City : NORTH HAVEN
State : CT
Zip : 06473-2304
Country : US
Telephone Number : 203-234-1324
Fax Number : 203-239-3047
Provider Business Practice Location Address
First Line : 31 BROADWAY
Second Line :
City : NORTH HAVEN
State : CT
Zip : 06473-2304
Country : US
Telephone Number : 203-234-1324
Fax Number : 203-239-3047
Authorized Official
Title or Position : MANAGING PHYSICIAN
Name : PAUL ALBERTI
Credential : MD
Telephone Number : 203-234-1324
Provider Enumeration Date : 11/07/2006
Last Update Date : 01/12/2024

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1265693493 — DR. JENNINE KELLEY A.U.D
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1790947042 — DR. MOIRA BELL A.U.D, CCC-A
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Directions to “EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC ” Practice Location

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