Provider Demographics
NPI:1093761330
Name:EAR, NOSE & THROAT CARE, P.C.
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BORTNIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-704-9696
Mailing Address - Street 1:242 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3019
Mailing Address - Country:US
Mailing Address - Phone:908-704-9696
Mailing Address - Fax:908-704-0097
Practice Address - Street 1:242 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3019
Practice Address - Country:US
Practice Address - Phone:908-704-9696
Practice Address - Fax:908-704-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA045343207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ014597Medicare PIN