Southern New England Ear, Nose, Throat and Facial Plastic Surgery Grou

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

Legal business name

SOUTHERN NEW ENGLAND EAR, NOSE, THROAT AND FACIAL PLASTIC SURGERY GROU

Practice address

One Long Wharf Drive
Suite #302
New Haven, CT 06511-5593

Phone

(203) 777-7500

Fax

(203) 777-8469

NPI assigned

Jun 19, 2009

Last updated

Nov 3, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Eiizabeth Irene Sullivan

Title

Ceo

Phone

(203) 777-7500

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Howard P Boey, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1306868229
  Medicare reassignment NPD
• Eaton Chen, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1619991015
  Medicare reassignment NPD
• Tiffany T Chen, M.D.

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1548603525

  Single Specialty

  Medicare reassignment NPD
• Mark A Dagostino, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1144230749
  Medicare reassignment NPD
• Paul L Fortgang, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1649292566
  Medicare reassignment NPD
• Ronald H Hirokawa, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1346267200
  Medicare reassignment NPD
• Keat-Jin Lee, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1891716502
  Medicare reassignment NPD
• John M Willett, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1295749752

  Otolaryngology/Facial Plastic Surgery

  Medicare reassignment NPD
• Ken Yanagisawa, MD

  • Otolaryngology Physician
  • New Haven, CT
  • NPI 1225055064
  Medicare reassignment NPD
• Maria N Byrne, MD

  • Otolaryngology Physician
  • Phoenix, AZ
  • NPI 1750303764

  CT

  Medicare reassignment NPD
• Jessica May Bautista

  • Physician Assistant
  • New Haven, CT
  • NPI 1659007052
  Medicare reassignment
• Mary Katherine Morrison

  • Physician Assistant
  • New Haven, CT
  • NPI 1386263010
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1215164058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE LONG WHARF DRIVE",
            "address_2": "SUITE #302",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115593",
            "telephone_number": "203-777-7500",
            "fax_number": "203-777-8469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE LONG WHARF DRIVE",
            "address_2": "SUITE #302",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115593",
            "telephone_number": "203-777-7500",
            "fax_number": "203-777-8469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN NEW ENGLAND EAR, NOSE, THROAT AND FACIAL PLASTIC SURGERY GROU",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-19",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "EIIZABETH",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-777-7500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CT",
            "license": "034314",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Connecticut Geriatric & Preventive Medicine LLC
• Southern Connecticut Internal Medicine
• Southern Connecticut Internal Medicine
• Southern Home Care Services, Inc.
• Southern New England Ear, Nose, Throat & Facial Plastic Surg GRP. LCP
• Southern New England Home Care
• Kristen Southwick, RN
• Kathrine Sowa
• Alyssa Spadaro, APRN
• Shahhan Spall, MD

• Otolaryngology/Facial Plastic Surgery Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.