Provider Demographics
NPI:1649214909
Name:MORRISTOWN OTOLARYNGOLOGY GROUP, LLC
Entity type:Organization
Organization Name:MORRISTOWN OTOLARYNGOLOGY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIDIER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-267-1851
Mailing Address - Street 1:26 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7310
Mailing Address - Country:US
Mailing Address - Phone:973-267-1851
Mailing Address - Fax:973-267-0024
Practice Address - Street 1:26 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7310
Practice Address - Country:US
Practice Address - Phone:973-267-1851
Practice Address - Fax:973-267-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF04934Medicare UPIN
NJ066567BWWMedicare ID - Type UnspecifiedDR. PERON PROVIDER#
NJ500384BWWMedicare ID - Type UnspecifiedDR. FLEMING PROVIDER #
NJB76720Medicare UPIN