Provider Demographics
NPI:1457715948
Name:ALLIANCE OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:ALLIANCE OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY LLC
Other - Org Name:BECKER ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-436-5740
Mailing Address - Street 1:1 UNION ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-4219
Mailing Address - Country:US
Mailing Address - Phone:609-436-5740
Mailing Address - Fax:609-436-5741
Practice Address - Street 1:1 UNION ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:609-436-5740
Practice Address - Fax:609-436-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty