Provider Demographics
NPI:1427071323
Name:NORTHEAST EAR, NOSE & THROAT CENTER, PC
Entity type:Organization
Organization Name:NORTHEAST EAR, NOSE & THROAT CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DEGENNARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-558-2624
Mailing Address - Street 1:940 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1007
Mailing Address - Country:US
Mailing Address - Phone:570-558-2624
Mailing Address - Fax:570-558-2479
Practice Address - Street 1:940 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1007
Practice Address - Country:US
Practice Address - Phone:570-558-2624
Practice Address - Fax:570-558-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
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
098973Medicare ID - Type Unspecified