Provider Demographics
NPI:1063591022
Name:NJ REGIONAL EAR NOSE & THROAT CENTER LLC
Entity type:Organization
Organization Name:NJ REGIONAL EAR NOSE & THROAT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-597-7110
Mailing Address - Street 1:1145 BEACON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2626
Mailing Address - Country:US
Mailing Address - Phone:609-597-7110
Mailing Address - Fax:609-597-9113
Practice Address - Street 1:1145 BEACON AVENUE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2626
Practice Address - Country:US
Practice Address - Phone:609-597-7110
Practice Address - Fax:609-597-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081299Medicaid
8222873OtherGHI
103892OtherLOCAL 825
NJ2411865000OtherAMERIHEALTH
=========OtherTRICARE
=========OtherQUALCARE
=========OtherUNITED HEALTHCARE
NJ2411865000OtherAMERIHEALTH
=========OtherHORIZON
8222873OtherGHI
=========OtherTRICARE
8222873OtherGHI