NPIMap

Organization Active NPI

Ear Nose & Throat Medical and Surgical Group, LLC

  • Nurse Practitioner
  • New Haven, CT
National Provider Identifier
1679835086
Registry record updated Jul 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
004907 Issued in CT
Legal business name
EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC
Practice address
46 Prince St Ste 601
New Haven, CT 06519-1634
Phone
(203) 752-1726
Fax
(203) 752-1838
NPI assigned
Jun 12, 2012
Last updated
Jul 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2012

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

Authorized official

Name
Dr. Agnes Czibulka, MDNPI 1407969686
Title
Physician Partner
Phone
(203) 234-1324

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
Nurse Practitioner 363L00000X 004907 CT Primary

Addresses

Primary practice location

46 Prince St Ste 601
New Haven, CT 06519-1634

Mailing address

31 Broadway
North Haven, CT 06473-2304
Phone (203) 234-1324

National Provider Directory

National Provider Directory

Locations

46 Prince St
Ste 601
New Haven, CT 06519
Phone (203) 752-1726

31 Broadway
North Haven, CT 06473
Phone (203) 234-1324

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEBFCA

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1679835086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 BROADWAY",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064732304",
            "telephone_number": "203-234-1324",
            "fax_number": "203-239-3047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 PRINCE ST STE 601",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191634",
            "telephone_number": "203-752-1726",
            "fax_number": "203-752-1838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "CZIBULKA",
        "authorized_official_first_name": "AGNES",
        "authorized_official_title_or_position": "PHYSICIAN PARTNER",
        "authorized_official_telephone_number": "203-234-1324",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "004907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.