Provider Demographics
NPI:1790854651
Name:EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-234-1324
Mailing Address - Street 1:31 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2304
Mailing Address - Country:US
Mailing Address - Phone:203-234-1324
Mailing Address - Fax:203-239-3047
Practice Address - Street 1:31 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2304
Practice Address - Country:US
Practice Address - Phone:203-234-1324
Practice Address - Fax:203-239-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004396140Medicaid