Provider Demographics
NPI:1912243270
Name:EAR, NOSE, & THROAT MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:EAR, NOSE, & THROAT MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-979-0662
Mailing Address - Street 1:108 BILBY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4174
Mailing Address - Country:US
Mailing Address - Phone:908-979-0662
Mailing Address - Fax:908-979-0713
Practice Address - Street 1:108 BILBY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4174
Practice Address - Country:US
Practice Address - Phone:908-979-0662
Practice Address - Fax:908-979-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63710207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty