Provider Demographics
NPI:1154430387
Name:EAR,NOSE&THROAT CARE OF WNY PC
Entity type:Organization
Organization Name:EAR,NOSE&THROAT CARE OF WNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PAOLINI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-6224
Mailing Address - Street 1:531 FARBER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5773
Mailing Address - Country:US
Mailing Address - Phone:716-634-6224
Mailing Address - Fax:
Practice Address - Street 1:531 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5773
Practice Address - Country:US
Practice Address - Phone:716-634-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
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
NY01766581Medicaid
NY01766581Medicaid
NYG47847Medicare UPIN