Provider Demographics
NPI:1275727828
Name:CHILDREN'S E.N.T., P.C.
Entity Type:Organization
Organization Name:CHILDREN'S E.N.T., P.C.
Other - Org Name:MICHAEL P. PIZZUTO, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PIZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-632-2000
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-332-3658
Practice Address - Street 1:8207 MAIN STREET STE 5
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-362-9730
Practice Address - Fax:716-213-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168257207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1003690OtherIHA
NY01247209Medicaid
NY00010139101OtherUNIVERA
NY000511120011OtherBLUE CROSS
NY1003690OtherIHA