Provider Demographics
NPI:1477912988
Name:PEDIATRIC EAR, NOSE & THROAT ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC EAR, NOSE & THROAT ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-212-6723
Mailing Address - Street 1:78 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2243
Mailing Address - Country:US
Mailing Address - Phone:860-212-6723
Mailing Address - Fax:860-232-2750
Practice Address - Street 1:65 LASALLE RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2374
Practice Address - Country:US
Practice Address - Phone:860-236-3277
Practice Address - Fax:860-232-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035460261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty