Provider Demographics
NPI:1568867067
Name:CAROLYN J. AGRESTI, M.D. EAR, NOSE AND THROAT, INC
Entity Type:Organization
Organization Name:CAROLYN J. AGRESTI, M.D. EAR, NOSE AND THROAT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-899-3822
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:STE 9700
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-899-3822
Mailing Address - Fax:561-899-3859
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:STE 9700
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-899-3822
Practice Address - Fax:561-899-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69697207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF25763Medicare UPIN