Provider Demographics
NPI:1750579744
Name:VERNOSE & MCGRATH OTOLARYNGOLOGY ASSOCIATES
Entity type:Organization
Organization Name:VERNOSE & MCGRATH OTOLARYNGOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:VERNOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-465-8800
Mailing Address - Street 1:1841 SOUTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148
Mailing Address - Country:US
Mailing Address - Phone:215-465-8800
Mailing Address - Fax:267-639-9971
Practice Address - Street 1:151 FRIES MILL ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-401-9155
Practice Address - Fax:856-401-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02962800207YX0007X
NJ25MB05747500207YX0007X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14573Medicare UPIN
B36970Medicare UPIN
NJ075518Medicare PIN