Provider Demographics
NPI:1629600135
Name:SOUTHERN NEW ENGLAND EAR, NOSE, THROAT & FACIAL PLASTIC SURG GRP. LCP
Entity Type:Organization
Organization Name:SOUTHERN NEW ENGLAND EAR, NOSE, THROAT & FACIAL PLASTIC SURG GRP. LCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANAGISAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-787-4244
Mailing Address - Street 1:ONE LONG WHARF DR.
Mailing Address - Street 2:SUITE #302
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5602
Mailing Address - Country:US
Mailing Address - Phone:203-777-7500
Mailing Address - Fax:203-777-8469
Practice Address - Street 1:ONE LONG WHARF DR.
Practice Address - Street 2:SUITE #302
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5602
Practice Address - Country:US
Practice Address - Phone:203-777-7500
Practice Address - Fax:203-777-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty