Bronx Ear Nose & Throat Associate PC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

195521 Issued in NY

Legal business name

BRONX EAR NOSE & THROAT ASSOCIATE PC

Practice address

3250 Westchester Ave
Ste #204
Bronx, NY 10461

Phone

(718) 409-2780

Fax

(718) 409-2786

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Leacroft Green, MDNPI 1740290279

Title

Owner

Phone

(718) 409-2780

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leacroft Green, MD

  • Surgery Physician
  • Brooklyn, NY
  • NPI 1740290279
  Medicare reassignment Authorized official
• Andrea Marie Plunkett, REGISTERED DIETITIAN

  • Registered Dietitian
  • Bronx, NY
  • NPI 1639674310
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1821163403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 WESTCHESTER AVE",
            "address_2": "STE #204",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10461",
            "telephone_number": "718-409-2780",
            "fax_number": "718-409-2786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 WESTCHESTER AVE",
            "address_2": "STE #204",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10461",
            "telephone_number": "718-409-2780",
            "fax_number": "718-409-2786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONX EAR NOSE & THROAT ASSOCIATE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "LEACROFT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-409-2780",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "195521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01677572",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Otolaryngology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.