Provider Demographics
NPI:1528112042
Name:PRINCETON EAR NOSE & THROAT PC
Entity type:Organization
Organization Name:PRINCETON EAR NOSE & THROAT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:DO FACS
Authorized Official - Phone:609-921-8800
Mailing Address - Street 1:MEDICAL ARTS BLDG
Mailing Address - Street 2:STE S 253 WITHERSPOON ST
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3211
Mailing Address - Country:US
Mailing Address - Phone:609-921-8800
Mailing Address - Fax:609-921-1761
Practice Address - Street 1:MEDICAL ARTS BLDG
Practice Address - Street 2:STE S 253 WITHERSPOON ST
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:609-921-8800
Practice Address - Fax:609-921-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB051472NJ207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07027Medicare UPIN
NJ698527Medicare PIN