Provider Demographics
NPI:1922208875
Name:ENGLEWOOD EAR NOSE & THROAT PC
Entity Type:Organization
Organization Name:ENGLEWOOD EAR NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-816-9800
Mailing Address - Street 1:216 ENGLE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2444
Mailing Address - Country:US
Mailing Address - Phone:201-816-9800
Mailing Address - Fax:207-567-1569
Practice Address - Street 1:216 ENGLE ST
Practice Address - Street 2:STE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2444
Practice Address - Country:US
Practice Address - Phone:201-816-9800
Practice Address - Fax:207-567-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ116093Medicare PIN