Provider Demographics
NPI:1003078585
Name:HEAD & NECK SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:HEAD & NECK SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:GARAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-871-4545
Mailing Address - Street 1:475 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4965
Mailing Address - Country:US
Mailing Address - Phone:201-871-4545
Mailing Address - Fax:201-871-9658
Practice Address - Street 1:475 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4965
Practice Address - Country:US
Practice Address - Phone:201-871-4545
Practice Address - Fax:201-871-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40253207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC60464Medicare UPIN