Provider Demographics
NPI:1437634938
Name:NORTHFIELD ENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHFIELD ENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-641-6644
Mailing Address - Street 1:2306 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1407
Mailing Address - Country:US
Mailing Address - Phone:609-641-6644
Mailing Address - Fax:
Practice Address - Street 1:2306 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1407
Practice Address - Country:US
Practice Address - Phone:609-641-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty