Provider Demographics
NPI:1730134982
Name:BROOKLINE EAR NOSE & THROAT, P.C.
Entity type:Organization
Organization Name:BROOKLINE EAR NOSE & THROAT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUZUKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-735-8855
Mailing Address - Street 1:1 BROOKLINE PL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7224
Mailing Address - Country:US
Mailing Address - Phone:617-735-8855
Mailing Address - Fax:617-735-8864
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:SUITE 401
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-735-8855
Practice Address - Fax:617-735-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14551OtherBLUE SHIELD
MA706243OtherTUFTS
MAM14551Medicare ID - Type Unspecified