Provider Demographics
NPI:1386611929
Name:SOUTH JERSEY EAR NOSE & THROAT ASSOCIATES P A
Entity type:Organization
Organization Name:SOUTH JERSEY EAR NOSE & THROAT ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-667-3700
Mailing Address - Street 1:1101 KINGS HWY N
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-667-3700
Mailing Address - Fax:856-667-5192
Practice Address - Street 1:1101 KINGS HWY N
Practice Address - Street 2:SUITE 306
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-667-3700
Practice Address - Fax:856-667-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000MA20638207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0157708Medicaid
=========OtherEMPLOYER ID NUMBER
017030Medicare PIN