Provider Demographics
NPI:1457315715
Name:UNIVERSITY OTOLARYNGOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:UNIVERSITY OTOLARYNGOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:NAGORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-762-4600
Mailing Address - Street 1:205 N BROAD ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1554
Mailing Address - Country:US
Mailing Address - Phone:215-762-4600
Mailing Address - Fax:215-988-0733
Practice Address - Street 1:205 N BROAD ST
Practice Address - Street 2:SUITE 401
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1554
Practice Address - Country:US
Practice Address - Phone:215-762-4600
Practice Address - Fax:215-988-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018866300Medicaid
PACG0580OtherRAIL ROAD MEDICARE
PA0018866300Medicaid