Provider Demographics
NPI:1922219484
Name:METROPOLITAN EAR NOSE AND THROAT & FACIAL PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:METROPOLITAN EAR NOSE AND THROAT & FACIAL PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-716-9716
Mailing Address - Street 1:201 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4043
Mailing Address - Country:US
Mailing Address - Phone:973-716-9716
Mailing Address - Fax:
Practice Address - Street 1:201 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 2G
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4043
Practice Address - Country:US
Practice Address - Phone:973-716-9716
Practice Address - Fax:973-716-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06012300207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ017866Medicare ID - Type Unspecified