Provider Demographics
NPI:1760961940
Name:NEW ENGLAND EAR NOSE & THROAT/FACIAL PLASTIC SURGERY,P.C.
Entity Type:Organization
Organization Name:NEW ENGLAND EAR NOSE & THROAT/FACIAL PLASTIC SURGERY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-685-7550
Mailing Address - Street 1:198 MASSACHUSETTS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-685-7550
Mailing Address - Fax:978-686-5565
Practice Address - Street 1:198 MASSACHUSETTS AVE STE 103
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-685-7550
Practice Address - Fax:978-686-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072121AMedicaid