Provider Demographics
NPI:1043240294
Name:THE OTOLARYNGOLOGY AND FACIAL PLASTICS CENTER
Entity Type:Organization
Organization Name:THE OTOLARYNGOLOGY AND FACIAL PLASTICS CENTER
Other - Org Name:OFP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-482-3223
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-482-3223
Mailing Address - Fax:516-482-2533
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-428-3223
Practice Address - Fax:516-482-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03193AMedicare PIN
NYWAA131Medicare PIN