Provider Demographics
NPI:1871843599
Name:ENT&SINUSCENTERABQPC
Entity Type:Organization
Organization Name:ENT&SINUSCENTERABQPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:BART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-506-2444
Mailing Address - Street 1:401 EDITH BLVD NE FL 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2525
Mailing Address - Country:US
Mailing Address - Phone:505-880-8118
Mailing Address - Fax:505-242-4187
Practice Address - Street 1:401 EDITH BLVD NE FL 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2525
Practice Address - Country:US
Practice Address - Phone:505-880-8118
Practice Address - Fax:505-242-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0046207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A09563Medicare UPIN