Provider Demographics
NPI:1790998805
Name:ATLANTIC ENT ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ATLANTIC ENT ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-223-8686
Mailing Address - Street 1:2640 HIGHWAY 70
Mailing Address - Street 2:BUILDING 6B
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2609
Mailing Address - Country:US
Mailing Address - Phone:732-223-8686
Mailing Address - Fax:732-223-6572
Practice Address - Street 1:2640 HIGHWAY 70
Practice Address - Street 2:BUILDING 6B
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:732-223-8686
Practice Address - Fax:732-223-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB55529207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6217401Medicaid
NJIA472218Medicare ID - Type Unspecified
G08253Medicare UPIN