Provider Demographics
NPI:1851629471
Name:CENTRAL JERSEY OTOLARYNGOLOGY LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY OTOLARYNGOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAVILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-389-2438
Mailing Address - Street 1:1131 BROAD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4329
Mailing Address - Country:US
Mailing Address - Phone:732-389-3388
Mailing Address - Fax:732-389-3389
Practice Address - Street 1:1131 BROAD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-389-3388
Practice Address - Fax:732-389-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty