Provider Demographics
NPI:1457726986
Name:PEDIATRIC OTOLARYNGOLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC OTOLARYNGOLOGIC ASSOCIATES
Other - Org Name:ENT INSTITUTE OF NEW JERSEY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:S
Authorized Official - Last Name:RESPLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-996-9200
Mailing Address - Street 1:2 S SUMMIT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1117
Mailing Address - Country:US
Mailing Address - Phone:201-996-9200
Mailing Address - Fax:201-928-0167
Practice Address - Street 1:2 S SUMMIT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1117
Practice Address - Country:US
Practice Address - Phone:201-996-9200
Practice Address - Fax:201-928-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 042686207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1034365OtherHORIZON NJ HEALTH