Provider Demographics
NPI:1538353321
Name:ASSOCIATES OF OTOLARYNGOLOGY PC
Entity type:Organization
Organization Name:ASSOCIATES OF OTOLARYNGOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-869-0177
Mailing Address - Street 1:PO BOX 10111
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-0111
Mailing Address - Country:US
Mailing Address - Phone:203-869-0177
Mailing Address - Fax:
Practice Address - Street 1:49 LAKE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4501
Practice Address - Country:US
Practice Address - Phone:203-869-0177
Practice Address - Fax:203-869-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026188207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA63762Medicare UPIN