Provider Demographics
NPI:1316147531
Name:EAR, NOSE & THROAT ASSOCIATION
Entity type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOERSCHIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-631-8899
Mailing Address - Street 1:21245 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1901
Mailing Address - Country:US
Mailing Address - Phone:718-762-0966
Mailing Address - Fax:
Practice Address - Street 1:21245 26TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1901
Practice Address - Country:US
Practice Address - Phone:718-762-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1892771174400000X
NY191884174400000X
NY140561174400000X
NY1829331174400000X
NY169492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF51727Medicare UPIN
NYB97264Medicare UPIN
NYE40710Medicare UPIN
NYG36816Medicare UPIN
NYG45877Medicare UPIN