Provider Demographics
NPI:1598066821
Name:NORTHEAST ENT, INC
Entity Type:Organization
Organization Name:NORTHEAST ENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:BR
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-995-0700
Mailing Address - Street 1:299 FAUNCE CORNER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1218
Mailing Address - Country:US
Mailing Address - Phone:508-207-4462
Mailing Address - Fax:508-995-3070
Practice Address - Street 1:191 BEDFORD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3011
Practice Address - Country:US
Practice Address - Phone:508-995-0700
Practice Address - Fax:508-995-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072097AMedicaid