Provider Demographics
NPI:1326362799
Name:NAUGATUCK VALLEY EAR, NOSE AND THROAT ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NAUGATUCK VALLEY EAR, NOSE AND THROAT ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-753-8833
Mailing Address - Street 1:171 GRANDVIEW AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2520
Mailing Address - Country:US
Mailing Address - Phone:203-753-8833
Mailing Address - Fax:203-753-6744
Practice Address - Street 1:171 GRANDVIEW AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2520
Practice Address - Country:US
Practice Address - Phone:203-753-8833
Practice Address - Fax:203-753-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty