Provider Demographics
NPI:1104910876
Name:ENT FACULTY PRACTICE LLP
Entity type:Organization
Organization Name:ENT FACULTY PRACTICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-693-7636
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-0708
Mailing Address - Country:US
Mailing Address - Phone:914-886-0024
Mailing Address - Fax:914-886-0041
Practice Address - Street 1:1055 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1045
Practice Address - Country:US
Practice Address - Phone:914-693-7636
Practice Address - Fax:914-886-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty