Provider Demographics
NPI:1699836197
Name:CONNECTICUT EAR NOSE THROAT MEDICAL AND SURGICAL SPECIALISTS PC
Entity Type:Organization
Organization Name:CONNECTICUT EAR NOSE THROAT MEDICAL AND SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-452-7081
Mailing Address - Street 1:15 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 2-8
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:203-452-7081
Mailing Address - Fax:203-452-7089
Practice Address - Street 1:15 CORPORATE DRIVE
Practice Address - Street 2:SUITE 2-8
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-452-7081
Practice Address - Fax:203-452-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02926Medicare PIN