Provider Demographics
NPI:1396818928
Name:NASSAU EAR NOSE & THROAT
Entity Type:Organization
Organization Name:NASSAU EAR NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-655-3000
Mailing Address - Street 1:2650 CONSTITUTION CENTER
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-3327
Mailing Address - Country:US
Mailing Address - Phone:609-655-3000
Mailing Address - Fax:609-655-3003
Practice Address - Street 1:2650 CONSTITUTION CENTER
Practice Address - Street 2:SUITE B
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3327
Practice Address - Country:US
Practice Address - Phone:609-655-3000
Practice Address - Fax:609-655-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
445932Medicare PIN