Provider Demographics
NPI:1619984580
Name:THE ENT SPECIALTY CENTER, PC
Entity Type:Organization
Organization Name:THE ENT SPECIALTY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-435-9100
Mailing Address - Street 1:THE ENT SPECIALTY CENTER, PC
Mailing Address - Street 2:PO BOX 8500-2901
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2901
Mailing Address - Country:US
Mailing Address - Phone:856-435-9100
Mailing Address - Fax:856-435-9112
Practice Address - Street 1:THE ENT SPECIALTY, PC 88 SOUTH LAKEVIEW DRIVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026
Practice Address - Country:US
Practice Address - Phone:856-435-9100
Practice Address - Fax:856-435-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E40074Medicare UPIN
NJ094802Medicare ID - Type Unspecified