Provider Demographics
NPI:1326362450
Name:DR GOTAY ENT GROUP LLC
Entity Type:Organization
Organization Name:DR GOTAY ENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOTAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-597-1002
Mailing Address - Street 1:171 GRANDVIEW AVENUE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2520
Mailing Address - Country:US
Mailing Address - Phone:203-597-1002
Mailing Address - Fax:203-575-9846
Practice Address - Street 1:171 GRANDVIEW AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2520
Practice Address - Country:US
Practice Address - Phone:203-597-1002
Practice Address - Fax:203-575-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty