Provider Demographics
NPI:1821276478
Name:EAR, NOSE & THROAT CENTER OF NJ
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT CENTER OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-9250
Mailing Address - Street 1:115 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2924
Mailing Address - Country:US
Mailing Address - Phone:973-773-9250
Mailing Address - Fax:973-773-9525
Practice Address - Street 1:115 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2924
Practice Address - Country:US
Practice Address - Phone:973-773-9250
Practice Address - Fax:973-773-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075875Medicare PIN