Provider Demographics
NPI:1861687295
Name:EAR, NOSE AND THROAT ASSOCIATES OF WATERBURY, PC
Entity Type:Organization
Organization Name:EAR, NOSE AND THROAT ASSOCIATES OF WATERBURY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIICIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:203-753-8833
Mailing Address - Street 1:171 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2517
Mailing Address - Country:US
Mailing Address - Phone:203-753-8833
Mailing Address - Fax:203-346-6977
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-753-8833
Practice Address - Fax:203-346-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty