Basic Information
| Provider Information | |||||||||
| NPI: | 1831109057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA EAR & SINUS CENTER PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 FLOYD ST | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342392932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413669222 | ||||||||
| FaxNumber: | 9413652269 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 FLOYD ST | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342392932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413669222 | ||||||||
| FaxNumber: | 9415564221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | SILVERSTEIN | ||||||||
| AuthorizedOfficialFirstName: | HERBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9413669222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLORIDA EAR & SINUS CENTER, PA | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YX0007X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207YX0901X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 251680200 | 05 | FL | MEDICAID |