EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC (NPI# 1679835086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679835086 |
| Entity Type | Organization |
| Organization Name | EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC |
| Practice Address |
46 Prince St Ste 601 New Haven CT 06519-1634 |
| Mailing Address |
31 Broadway North Haven CT 06473-2304 |
| Practice Telephone | 2037521726 |
| Practice Fax Number | 2037521838 |
| Mailing Telephone | 2032341324 |
| Mailing Fax Number | 2032393047 |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2012-07-16 |
| Authorized Official Name | DR. AGNES CZIBULKA (PHYSICIAN PARTNER) |
| Authorized Official Telephone | 2032341324 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 004907 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
46 PRINCE ST STE 601 |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06519-1634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972163319 | Elizabeth Maria Ayotte | Audiologist | 46 Prince St Ste 601, New Haven, CT 06519-1634 | 2019-06-18 |
| 1538681416 | Marisa Husereau | Audiologist | 46 Prince St Ste 601, New Haven, CT 06519-1634 | 2017-07-12 |
| 1780106690 | Amanda Ottochian | Audiologist | 46 Prince St Ste 601, New Haven, CT 06519-1634 | 2017-07-12 |
| 1700136827 | Kelly K Greco | Nurse Practitioner | 46 Prince St Ste 601, New Haven, CT 06519-1634 | 2012-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255819348 | Jordan Ficocelli | Nurse Practitioner | 800 Howard Ave # 2, New Haven, CT 06519 | 2018-08-01 |
| 1780123414 | Claire Louise Hardin | General Acute Care Hospital | 95 Howard Ave, New Haven, CT 06519 | 2017-02-14 |
| 1467809137 | Ana Laura Vives-rodriguez | Student in an Organized Health Care Education/Training Program | 800 Howard Avenue, Lower Level, Yale Physicians Building, New Haven, CT 06519 | 2016-05-23 |
| 1346607785 | Amanda Kayte Corcoran | Advanced Practice Midwife | 40 Prince St., Suite 207, New Haven, CT 06519 | 2016-01-15 |
| 1720491905 | Sara Harcharik Perkins | Dermatology | 2 Church St S Ste 305, New Haven, CT 06519 | 2014-06-05 |
| 1194136713 | Krishan Ratilal Jethwa | Radiology | 35 Park St Ste Ll507, New Haven, CT 06519 | 2014-05-16 |
| 1235549353 | Brandon Michael Kitay | Psychiatry & Neurology | 184 Liberty St # Lv108, New Haven, CT 06519 | 2014-04-28 |
| 1649526617 | Yale New Haven Hospital | Student in an Organized Health Care Education/Training Program | 330 Cedar St Fmb 107, Yale New Haven Hospital, Dept of Surgery, New Haven, CT 06519 | 2012-07-27 |
| 1669736765 | Mayanka Tickoo | Internal Medicine | 300 Cedar St Fl 4, New Haven, CT 06519 | 2012-07-03 |
| 1730441627 | Judith A Ross | Physical Therapist | 18 Tower Lane, Tower One Tower East, New Haven, CT 06519 | 2012-06-15 |
| Find all providers in zip 06519 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679121479 | Sarah C Scott | Nurse Practitioner | 175 Sherman Ave Fl 2, New Haven, CT 06511-4358 | 2019-08-27 |
| 1255819348 | Jordan Ficocelli | Nurse Practitioner | 800 Howard Ave # 2, New Haven, CT 06519 | 2018-08-01 |
| 1922584549 | Kathryn Dzurilla | Nurse Practitioner | 20 York St. Cb-2041, New Haven, CT 06510-3220 | 2018-07-17 |
| 1295146215 | Amanda Kuula-johnson | Nurse Practitioner | 58337 Thomas Dr, New Haven, MI 48048-3326 | 2014-05-13 |
| 1619275567 | Laura Ann Tipping Wilhelm | Nurse Practitioner | 675 Townsend Ave, New Haven, CT 06512-3101 | 2011-03-02 |
| 1154492015 | Ranbir Bains | Nurse Practitioner | 1460 Chapel St, New Haven, CT 06519-1233 | 2006-11-13 |
| 1699729475 | Dorothea Smith | Nurse Practitioner | 2 Church St., New Haven, CT 06519 | 2006-05-19 |
| 1578524641 | Debra Faye Danzinger | Nurse Practitioner | 323 Center St, New Haven, KY 40051-6319 | 2006-03-29 |
| 1821090507 | Robin Lee Phillips | Nurse Practitioner | 20 York Street, Cb-2041, New Haven, CT 06510-3220 | 2005-08-12 |
| 1922004290 | Danielle Morgan | Nurse Practitioner | 846 State St, New Haven, CT 06511-3924 | 2005-06-22 |
| Find all providers in NEW HAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.