Organization
NORTHWEST EAR NOSE &THROAT SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXIS C BOUTENEFF MD (MD)
(860) 496-9565
Entity
Organization
Contact information
Practice address
16 BIRD ST, TORRINGTON, CT 06790-3812
(860) 496-9565
(860) 496-9875
Mailing address
16 BIRD ST, TORRINGTON, CT 06790-3812
(860) 496-9565
(860) 496-9875
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO1258
MEDICARE GROUP NUMBER
CT
Enumeration date
11/09/2007
Last updated
05/27/2009
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