Provider Demographics
NPI:1164556858
Name:REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES
Entity Type:Organization
Organization Name:REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES
Other - Org Name:PROFESSIONAL OTOLARYNGOLOGY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-667-1575
Mailing Address - Street 1:200 BOWMAN DRIVE
Mailing Address - Street 2:SUITE D285
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-602-4000
Mailing Address - Fax:856-946-1747
Practice Address - Street 1:200 BOWMAN DRIVE
Practice Address - Street 2:SUITE D285
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-602-4000
Practice Address - Fax:856-946-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072422Medicare ID - Type UnspecifiedGROUP MEDICARE NO.