Provider Demographics
NPI:1144215807
Name:ENT & FACIAL PLASTIC SURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:ENT & FACIAL PLASTIC SURGICAL ASSOCIATES, LLP
Other - Org Name:PREMIER E.N.T. ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-757-7300
Mailing Address - Street 1:400 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1819
Mailing Address - Country:US
Mailing Address - Phone:215-757-7300
Mailing Address - Fax:215-750-7111
Practice Address - Street 1:400 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1819
Practice Address - Country:US
Practice Address - Phone:215-757-7300
Practice Address - Fax:215-750-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA137282Medicare PIN
PACJ4136Medicare PIN