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Organization

EAR,NOSE AND THROAT SPECIALISTS,PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RODOLFO DIAZ M.D. (PHYSICIAN)
(856) 696-5510
Entity
Organization

Contact information

Practice address
1206 W SHERMAN AVE STE 2B, VINELAND, NJ 08360-6911
(856) 696-5510
(856) 696-5590
Mailing address
1206 W SHERMAN AVE, SUITE B2, VINELAND, NJ 08360-6916
(856) 696-5510
(856) 696-5590

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
25MA04900200
NJ
207Y00000X
Otolaryngology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01000270500
AMERICHOICE
NJ
01
0466509000
AMERIHEALTH
NJ
01
1079307
HORIZON NJ HEALTH
NJ
05
5281300
NJ
Enumeration date
03/14/2006
Last updated
03/24/2021
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