# SOUTHERN NEW ENGLAND EAR, NOSE, THROAT AND FACIAL PLASTIC SURGERY GROU

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215164058
- **Authorized official:** MRS. EIIZABETH IRENE SULLIVAN (CEO)
- **Authorized official phone:** (203) 777-7500

## Contact information

- **Practice address:** ONE LONG WHARF DRIVE, SUITE \#302, NEW HAVEN, CT 06511-5593
- **Practice address phone:** (203) 777-7500
- **Practice address fax:** (203) 777-8469
- **Mailing address:** ONE LONG WHARF DRIVE, SUITE \#302, NEW HAVEN, CT 06511-5593
- **Mailing address phone:** (203) 777-7500
- **Mailing address fax:** (203) 777-8469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 034314 | CT | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/19/2009
- **Last updated:** 11/03/2015