Provider Demographics
NPI:1154445559
Name:ADVANCED EARS NOSE AND THROAT LLC
Entity Type:Organization
Organization Name:ADVANCED EARS NOSE AND THROAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:RAMZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-709-0860
Mailing Address - Street 1:774 CHRISTIANA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4236
Mailing Address - Country:US
Mailing Address - Phone:302-709-0860
Mailing Address - Fax:302-709-0863
Practice Address - Street 1:774 CHRISTIANA RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-709-0860
Practice Address - Fax:302-709-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003646207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024172Medicaid
DEE22383Medicare UPIN
DEG01490Medicare ID - Type UnspecifiedMEDICARE