Provider Demographics
NPI:1417144239
Name:CORTLAND ENT, PC
Entity Type:Organization
Organization Name:CORTLAND ENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-753-6560
Mailing Address - Street 1:64 POMEROY ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2708
Mailing Address - Country:US
Mailing Address - Phone:607-753-6560
Mailing Address - Fax:607-753-6566
Practice Address - Street 1:64 POMEROY ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2708
Practice Address - Country:US
Practice Address - Phone:607-753-6560
Practice Address - Fax:607-753-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241226207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02806619Medicaid
NY02806619Medicaid