Provider Demographics
NPI:1710554217
Name:MASSACHUSETTS EAR NOSE AND THROAT ASSOCIATES 4 LLC
Entity Type:Organization
Organization Name:MASSACHUSETTS EAR NOSE AND THROAT ASSOCIATES 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-256-5557
Mailing Address - Street 1:321 BILLERICA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4100
Mailing Address - Country:US
Mailing Address - Phone:978-256-5557
Mailing Address - Fax:978-256-1835
Practice Address - Street 1:100 UNICORN PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3379
Practice Address - Country:US
Practice Address - Phone:978-256-5557
Practice Address - Fax:978-256-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0109100Medicaid