Provider Demographics
NPI:1679528426
Name:REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES, LLC
Entity Type:Organization
Organization Name:REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES, LLC
Other - Org Name:ASSOCIATES IN EAR, NOSE AND THROAT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-667-1575
Mailing Address - Street 1:PO BOX 95000-5585
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-5585
Mailing Address - Country:US
Mailing Address - Phone:856-667-1575
Mailing Address - Fax:856-210-2849
Practice Address - Street 1:1020 N KINGS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-667-1575
Practice Address - Fax:856-210-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072422Medicare ID - Type Unspecified
NJ072422Medicare PIN