Provider Demographics
NPI:1154503951
Name:NORTHEAST ENT, INC
Entity Type:Organization
Organization Name:NORTHEAST ENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-995-0700
Mailing Address - Street 1:300A FAUNCE CORNER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1280
Mailing Address - Country:US
Mailing Address - Phone:508-995-0700
Mailing Address - Fax:508-995-3070
Practice Address - Street 1:300A FAUNCE CORNER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1280
Practice Address - Country:US
Practice Address - Phone:508-995-0700
Practice Address - Fax:508-995-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
36162OtherHARVARD PILGRIM
SP0029OtherBLUE CROSS BLUE SHIELD MA