Provider Demographics
NPI:1487662995
Name:EAR, NOSE & THROAT SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INKWIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-235-3345
Mailing Address - Street 1:1064 E MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4898
Mailing Address - Country:US
Mailing Address - Phone:203-235-3345
Mailing Address - Fax:203-235-5658
Practice Address - Street 1:1064 E MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4898
Practice Address - Country:US
Practice Address - Phone:203-235-3345
Practice Address - Fax:203-235-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCL0983OtherRAILROAD MEDICARE
CT4002804Medicaid
CT4002804Medicaid
CT=========OtherFEDERAL TAX ID