NPIMap

Organization Active NPI

Atlantic ENT Group LLC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Red Bank, NJ
National Provider Identifier
1629294079
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
Legal business name
ATLANTIC ENT GROUP LLC
Practice address
370 State Highway 35
Suite 100
Red Bank, NJ 07701
Phone
(732) 530-7799
Fax
(732) 530-9091
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Anthony Degennaro, MDNPI 1528137262
Title
President
Phone
(732) 530-7799

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0007X Primary

Addresses

Primary practice location

370 State Highway 35
Suite 100
Red Bank, NJ 07701

Mailing address

370 State Highway 35
Suite 100
Red Bank, NJ 07701
Phone (732) 530-7799

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080605000615 NJ Part B Supplier - Clinic/Group Practice 5799855508 Receives reassigned benefits from 1 practitioner
Practice locations: Red Bank, NJ

National Provider Directory

National Provider Directory

Locations

370 Highway 35
Ste 100
Red Bank, NJ 07701
Phone (732) 345-0555

Practitioners & affiliated clinicians

Practitioners 7

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629294079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 STATE HIGHWAY 35",
            "address_2": "SUITE 100",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "07701",
            "telephone_number": "732-530-7799",
            "fax_number": "732-530-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 STATE HIGHWAY 35",
            "address_2": "SUITE 100",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "07701",
            "telephone_number": "732-530-7799",
            "fax_number": "732-530-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC ENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEGENNARO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-530-7799",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bank, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.