NPIMap

Organization Active NPI

Eastern Connecticut Ear, Nose & Throat PC

  • Otolaryngology Physician
  • Willimantic, CT
National Provider Identifier
1861560922
Registry record updated Feb 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
EASTERN CONNECTICUT EAR, NOSE & THROAT PC
Practice address
36 Watson St
Willimantic, CT 06226-2122
Phone
(860) 456-0287
Fax
(860) 456-3532
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2018

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

Authorized official

Name
Debra Tino
Title
Practice Manager
Phone
(860) 456-0287

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X Primary
Facial Plastic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207YS0123X
Otolaryngic Allergy PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207YX0602X
Hearing Aid Equipment 332S00000X 000208 CT

Addresses

Primary practice location

36 Watson St
Willimantic, CT 06226-2122

Mailing address

36 Watson St
Willimantic, CT 06226-2122
Phone (860) 456-0287

Other identifiers 2

IdentifierTypeStateIssuer
004170742MedicaidCT
004054151MedicaidCT

National Provider Directory

National Provider Directory

Locations

36 Watson St
Willimantic, CT 06226
Phone (860) 423-0287

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519257600000",
    "number": "1861560922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 WATSON ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262122",
            "telephone_number": "860-456-0287",
            "fax_number": "860-456-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 WATSON ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262122",
            "telephone_number": "860-456-0287",
            "fax_number": "860-456-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN CONNECTICUT EAR, NOSE & THROAT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2018-02-22",
        "status": "A",
        "authorized_official_last_name": "TINO",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "860-456-0287"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": "CT",
            "license": "000208",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004170742",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004054151",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; 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.