Provider Demographics
NPI:1710010145
Name:REGIONAL OTOLARYNGOLOGY HEAD & NECK ASSOCIATES, LLC
Entity Type:Organization
Organization Name:REGIONAL OTOLARYNGOLOGY HEAD & NECK ASSOCIATES, LLC
Other - Org Name:PROFESSIONAL OTOLARYNGOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:856-848-0700
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:BUILDING A, SUITE 100
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-346-0200
Mailing Address - Fax:856-309-8192
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:BUILDING A, SUITE 100
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2176
Practice Address - Country:US
Practice Address - Phone:856-346-0200
Practice Address - Fax:856-309-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072422Medicare ID - Type UnspecifiedGROUP MEDICARE NO.