Provider Demographics
NPI:1558496109
Name:ASSOCIATED EAR, NOSE & THROAT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ASSOCIATED EAR, NOSE & THROAT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-586-2111
Mailing Address - Street 1:901 FARMINGTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1418
Mailing Address - Country:US
Mailing Address - Phone:860-586-2111
Mailing Address - Fax:860-586-2114
Practice Address - Street 1:901 FARMINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1418
Practice Address - Country:US
Practice Address - Phone:860-586-2111
Practice Address - Fax:860-586-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004205268Medicaid
C02812Medicare ID - Type Unspecified