Provider Demographics
NPI:1831191824
Name:SOUTH JERSEY ENT SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:SOUTH JERSEY ENT SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VYTAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:SILIUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DP
Authorized Official - Phone:609-927-8881
Mailing Address - Street 1:2106 NEW RD
Mailing Address - Street 2:C9
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1046
Mailing Address - Country:US
Mailing Address - Phone:609-927-8881
Mailing Address - Fax:609-927-8832
Practice Address - Street 1:2106 NEW RD
Practice Address - Street 2:C9
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1046
Practice Address - Country:US
Practice Address - Phone:609-927-8881
Practice Address - Fax:609-927-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075955Medicare ID - Type Unspecified