Provider Demographics
NPI:1134292105
Name:POCONO EAR NOSE THROAT & FACIAL PLASTIC SURGERY, ASSOCIATES
Entity Type:Organization
Organization Name:POCONO EAR NOSE THROAT & FACIAL PLASTIC SURGERY, ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSAIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:570-424-2830
Mailing Address - Street 1:296 EAST BROWN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-424-2830
Mailing Address - Fax:570-424-1793
Practice Address - Street 1:296 EAST BROWN STREET
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-424-2830
Practice Address - Fax:570-424-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA036586207Y00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017769230005Medicaid
PA0017769230005Medicaid
PAC341184Medicare UPIN