Provider Demographics
NPI:1417021015
Name:PALM BEACH EAR, NOSE & THROAT ASSOCIATION PA
Entity Type:Organization
Organization Name:PALM BEACH EAR, NOSE & THROAT ASSOCIATION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-659-2266
Mailing Address - Street 1:1515 N FLAGLER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3430
Mailing Address - Country:US
Mailing Address - Phone:561-659-2266
Mailing Address - Fax:561-659-7846
Practice Address - Street 1:1515 N FLAGLER DR STE 600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3430
Practice Address - Country:US
Practice Address - Phone:561-659-2266
Practice Address - Fax:561-659-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99064Medicare ID - Type UnspecifiedGROUP