Provider Demographics
NPI:1982793675
Name:PLANTATION EAR NOSE & THROAT PA
Entity Type:Organization
Organization Name:PLANTATION EAR NOSE & THROAT PA
Other - Org Name:HERBERT I MOSELLE MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-472-1212
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-472-1212
Mailing Address - Fax:954-473-6235
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-472-1212
Practice Address - Fax:954-473-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34163OtherGROUP NUMBER FOR BCBS
FLK3271Medicare PIN