Provider Demographics
NPI:1437197092
Name:NEW ENGLAND EAR NOSE & THROAT/FACIAL PLASTIC SURGERY,P.C.
Entity Type:Organization
Organization Name:NEW ENGLAND EAR NOSE & THROAT/FACIAL PLASTIC SURGERY,P.C.
Other - Org Name:ANDOVER EAR NOSE AND THROAT CENTER P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:POSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-685-7550
Mailing Address - Street 1:198 MASSACHUSETTS AVE
Mailing Address - Street 2:#103
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-685-7550
Mailing Address - Fax:978-686-5565
Practice Address - Street 1:198 MASSACHUSETTS AVE
Practice Address - Street 2:#103
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-685-7550
Practice Address - Fax:978-686-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15965OtherBLUE SHIELD
MA9773711Medicaid
M15965Medicare ID - Type Unspecified