Provider Demographics
NPI:1629294079
Name:ATLANTIC ENT GROUP LLC
Entity Type:Organization
Organization Name:ATLANTIC ENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGENNARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-530-7799
Mailing Address - Street 1:370 STATE HIGHWAY 35
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-530-7799
Mailing Address - Fax:732-530-9091
Practice Address - Street 1:370 STATE HIGHWAY 35
Practice Address - Street 2:SUITE 100
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-530-7799
Practice Address - Fax:732-530-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty