Provider Demographics
NPI:1164714317
Name:DRAKE & PRESTI ENT SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:DRAKE & PRESTI ENT SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:908-233-2111
Mailing Address - Street 1:213 SUMMIT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2316
Mailing Address - Country:US
Mailing Address - Phone:908-233-2111
Mailing Address - Fax:
Practice Address - Street 1:213 SUMMIT RD STE 1
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2316
Practice Address - Country:US
Practice Address - Phone:908-233-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06063900207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty