Provider Demographics
NPI:1538230313
Name:PINNACLE ENT ALLIANCE LLC
Entity type:Organization
Organization Name:PINNACLE ENT ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:I
Authorized Official - Last Name:SURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-446-6900
Mailing Address - Street 1:PO BOX 822336
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2336
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-471-0565
Practice Address - Street 1:994 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE 1017
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1802
Practice Address - Country:US
Practice Address - Phone:610-902-6092
Practice Address - Fax:610-471-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098583Medicare PIN