Basic Information
| Provider Information | |||||||||
| NPI: | 1922564541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENT OF BROOKLYN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2625 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100098925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142220828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 BROADWAY | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112118755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182256100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2019 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | PANTELIDES | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7182256100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.