Provider Demographics
NPI:1174005219
Name:EAR SPECIALTY GROUP OF CONNECTICUT PC
Entity Type:Organization
Organization Name:EAR SPECIALTY GROUP OF CONNECTICUT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HANNAH
Authorized Official - Last Name:ROSTRON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:860-640-4455
Mailing Address - Street 1:40 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2454
Mailing Address - Country:US
Mailing Address - Phone:860-640-4455
Mailing Address - Fax:860-640-4478
Practice Address - Street 1:40 STANFORD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2454
Practice Address - Country:US
Practice Address - Phone:860-640-4455
Practice Address - Fax:860-640-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty