Basic Information
Provider Information
NPI: 1619984580
EntityType: 2
ReplacementNPI:  
OrganizationName: THE ENT SPECIALTY CENTER, PC
LastName:  
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Mailing Information
Address1: THE ENT SPECIALTY CENTER, PC
Address2: PO BOX 8500-2901
City: PHILADELPHIA
State: PA
PostalCode: 191782901
CountryCode: US
TelephoneNumber: 8564359100
FaxNumber: 8564359112
Practice Location
Address1: THE ENT SPECIALTY, PC 88 SOUTH LAKEVIEW DRIVE
Address2: BUILDING 1
City: GIBBSBORO
State: NJ
PostalCode: 08026
CountryCode: US
TelephoneNumber: 8564359100
FaxNumber: 8564359112
Other Information
ProviderEnumerationDate: 08/02/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: SCHAFFER
AuthorizedOfficialFirstName: SCOTT
AuthorizedOfficialMiddleName: RICHARD
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8564359100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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