Basic Information
| Provider Information | |||||||||
| NPI: | 1669437018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT T SATALOFF, MD AND ASSOC, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PHILADELPHIA EAR, NOSE & THROAT ASSOC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 N. BROAD STREET | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625530 | ||||||||
| FaxNumber: | 2157625540 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 N. BROAD STREET | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625530 | ||||||||
| FaxNumber: | 2157625540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | SATALOFF | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | THAYER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2157625530 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROBERT T. SATALOFF, MD & ASSOCIATES, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 101397352 | 05 | PA | MEDICAID |