Provider Demographics
NPI:1710959499
Name:BERKS E.N.T. SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BERKS E.N.T. SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-376-3738
Mailing Address - Street 1:1 GRANITE POINT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1986
Mailing Address - Country:US
Mailing Address - Phone:610-376-9728
Mailing Address - Fax:610-376-4780
Practice Address - Street 1:1 GRANITE POINT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1986
Practice Address - Country:US
Practice Address - Phone:610-376-9728
Practice Address - Fax:610-376-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039384Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #