Provider Demographics
NPI:1528168705
Name:CONNECTICUT EAR, NOSE & THROAT ASSOCIATES, P.C.
Entity type:Organization
Organization Name:CONNECTICUT EAR, NOSE & THROAT ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-493-1950
Mailing Address - Street 1:988 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4227
Mailing Address - Country:US
Mailing Address - Phone:860-493-1950
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:988 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4227
Practice Address - Country:US
Practice Address - Phone:860-493-1950
Practice Address - Fax:860-493-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004136538Medicaid
CTC01734Medicare ID - Type Unspecified