Provider Demographics
NPI:1700974995
Name:THE NEW JERSEY CENTER FOR EAR, NOSE AND THROAT DISORDERS, P.C.
Entity Type:Organization
Organization Name:THE NEW JERSEY CENTER FOR EAR, NOSE AND THROAT DISORDERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-592-5800
Mailing Address - Street 1:301 BRIDGE PLZ N
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5059
Mailing Address - Country:US
Mailing Address - Phone:201-592-8200
Mailing Address - Fax:201-592-7786
Practice Address - Street 1:301 BRIDGE PLZ N
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5059
Practice Address - Country:US
Practice Address - Phone:201-592-8200
Practice Address - Fax:201-592-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06039500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF67180Medicare UPIN
NJ134533Medicare ID - Type Unspecified