NPIMap

Organization Active NPI

Naugatuck Valley Ear, Nose and Throat Associates, LLC

  • Otolaryngology Physician
  • Waterbury, CT
National Provider Identifier
1326362799
Registry record updated Mar 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
NAUGATUCK VALLEY EAR, NOSE AND THROAT ASSOCIATES, LLC
Practice address
171 Grandview Avenue
Suite 201
Waterbury, CT 06708-2520
Phone
(203) 753-8833
Fax
(203) 753-6744
NPI assigned
Mar 15, 2010
Last updated
Mar 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2010

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

Authorized official

Name
Raymond E. Winicki, M.D.NPI 1720083421
Title
Principal Member
Phone
(203) 753-8833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Otolaryngology Physician 207Y00000X Primary
Audiologist 231H00000X

Addresses

Primary practice location

171 Grandview Avenue
Suite 201
Waterbury, CT 06708-2520

Mailing address

171 Grandview Avenue
Suite 201
Waterbury, CT 06708-2520
Phone (203) 753-8833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100511000604 CT Part B Supplier - Clinic/Group Practice 7012045107 Receives reassigned benefits from 11 practitioners
Practice locations: Waterbury, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2006967Naugatuck Valley Ear, Nose and Throat Assoc171 Grandview Ave, Waterbury, CT 06708Certificate of waiverMay 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1326362799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 GRANDVIEW AVENUE",
            "address_2": "SUITE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082520",
            "telephone_number": "203-753-8833",
            "fax_number": "203-753-6744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 GRANDVIEW AVENUE",
            "address_2": "SUITE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082520",
            "telephone_number": "203-753-8833",
            "fax_number": "203-753-6744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAUGATUCK VALLEY EAR, NOSE AND THROAT ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "WINICKI",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRINCIPAL MEMBER",
        "authorized_official_telephone_number": "203-753-8833",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.