Provider Demographics
NPI:1003856048
Name:MANCHESTER EAR, NOSE & THROAT CENTER LLC
Entity Type:Organization
Organization Name:MANCHESTER EAR, NOSE & THROAT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHTERNFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-648-0860
Mailing Address - Street 1:2800 TAMARACK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-9999
Mailing Address - Country:US
Mailing Address - Phone:860-648-0860
Mailing Address - Fax:860-648-0870
Practice Address - Street 1:2800 TAMARACK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-9999
Practice Address - Country:US
Practice Address - Phone:860-648-0860
Practice Address - Fax:860-648-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040529207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65629Medicare UPIN
C02998Medicare ID - Type Unspecified