Provider Demographics
NPI:1306987060
Name:ERNEST M. ENZIEN MD, PC
Entity type:Organization
Organization Name:ERNEST M. ENZIEN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:MACLAREN
Authorized Official - Last Name:ENZIEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-732-6444
Mailing Address - Street 1:1705 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5642
Mailing Address - Country:US
Mailing Address - Phone:315-732-6444
Mailing Address - Fax:315-732-4448
Practice Address - Street 1:1705 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5642
Practice Address - Country:US
Practice Address - Phone:315-732-6444
Practice Address - Fax:315-732-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00578161Medicaid
NY01182598OtherGHI
NM045111OtherMVP
NY01182598OtherGHI
NY00578161Medicaid