Provider Demographics
NPI:1841490067
Name:ENT SPECIALTY CARE
Entity type:Organization
Organization Name:ENT SPECIALTY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-294-0661
Mailing Address - Street 1:2004 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5210
Mailing Address - Country:US
Mailing Address - Phone:845-294-0661
Mailing Address - Fax:845-818-9646
Practice Address - Street 1:30 MATTHEWS ST #105
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1985
Practice Address - Country:US
Practice Address - Phone:845-294-0661
Practice Address - Fax:845-818-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183723207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCR54OtherCDPHP
NYLA0WWT4710OtherEMPIRE NEW YORK BC/BS
NYCR54OtherCDPHP
NYLA0WWT4710OtherEMPIRE NEW YORK BC/BS