Provider Demographics
NPI:1356182216
Name:ENT MEDICAL SPECIALISTS PA
Entity type:Organization
Organization Name:ENT MEDICAL SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-943-1418
Mailing Address - Street 1:4515 WILES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3414
Mailing Address - Country:US
Mailing Address - Phone:954-943-1418
Mailing Address - Fax:786-662-3670
Practice Address - Street 1:4515 WILES RD STE 201
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3414
Practice Address - Country:US
Practice Address - Phone:954-943-1418
Practice Address - Fax:786-662-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty