Provider Demographics
NPI:1902029416
Name:NORTH JERSEY OTOLARYNGOLOGY-HEAD AND NECK SURGERY,PA
Entity Type:Organization
Organization Name:NORTH JERSEY OTOLARYNGOLOGY-HEAD AND NECK SURGERY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-773-9880
Mailing Address - Street 1:1070 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3619
Mailing Address - Country:US
Mailing Address - Phone:973-773-9880
Mailing Address - Fax:
Practice Address - Street 1:1070 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3619
Practice Address - Country:US
Practice Address - Phone:973-773-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2961504Medicaid
NJ2961504Medicaid