Provider Demographics
NPI:1487717575
Name:OTOLARYNGOLOGY PLASTIC SURGERY ASSOCIATES, PC
Entity type:Organization
Organization Name:OTOLARYNGOLOGY PLASTIC SURGERY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTURZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-348-1152
Mailing Address - Street 1:2100 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1052
Mailing Address - Country:US
Mailing Address - Phone:215-368-5290
Mailing Address - Fax:215-348-7416
Practice Address - Street 1:2100 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1052
Practice Address - Country:US
Practice Address - Phone:215-368-5290
Practice Address - Fax:215-348-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA92827Medicare ID - Type Unspecified