Provider Demographics
NPI:1508964545
Name:EAR NOSE & THROAT PROFESSIONAL ASSOCIATES
Entity Type:Organization
Organization Name:EAR NOSE & THROAT PROFESSIONAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:L
Authorized Official - Last Name:RONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-790-1553
Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:STE 1405
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-790-1553
Mailing Address - Fax:215-735-4977
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:STE 1405
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-790-1553
Practice Address - Fax:215-735-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053359000OtherIBC
PA116585100OtherDEPARTMENT OF LABOR
PA0053359000OtherIBC
PA116585100OtherDEPARTMENT OF LABOR