Provider Demographics
NPI:1417065392
Name:ASSOCIATES IN OTOLARYNGOLOGY OF NJ, P.A.
Entity Type:Organization
Organization Name:ASSOCIATES IN OTOLARYNGOLOGY OF NJ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-243-0600
Mailing Address - Street 1:741 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1174
Mailing Address - Country:US
Mailing Address - Phone:973-243-0600
Mailing Address - Fax:973-736-5702
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-243-0600
Practice Address - Fax:973-736-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2606909Medicaid
NJ620416Medicare PIN