Provider Demographics
NPI:1629095633
Name:EAR, NOSE AND THROAT GROUP OF CENTRAL NEW JERSEY
Entity Type:Organization
Organization Name:EAR, NOSE AND THROAT GROUP OF CENTRAL NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-205-1311
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-0250
Mailing Address - Country:US
Mailing Address - Phone:732-205-1311
Mailing Address - Fax:732-205-9648
Practice Address - Street 1:2124 OAK TREE RD FL 2
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-205-1311
Practice Address - Fax:732-205-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Y00000X
NJD01481300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ835984Medicare PIN