Provider Demographics
NPI:1356639454
Name:SOUTH FLORIDA ENT ASSOCIATES HEARING, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA ENT ASSOCIATES HEARING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-558-3724
Mailing Address - Street 1:14750 NW 77TH CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-662-3669
Practice Address - Street 1:14750 NW 77TH CT
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1507
Practice Address - Country:US
Practice Address - Phone:305-558-3724
Practice Address - Fax:786-662-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty