Provider Demographics
NPI:1871588046
Name:ENZER & ASSOCIATES, PC
Entity type:Organization
Organization Name:ENZER & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOASH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ENZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-274-4464
Mailing Address - Street 1:120 DUDLEY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2436
Mailing Address - Country:US
Mailing Address - Phone:401-274-4464
Mailing Address - Fax:401-831-0710
Practice Address - Street 1:120 DUDLEY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2436
Practice Address - Country:US
Practice Address - Phone:401-274-4464
Practice Address - Fax:401-831-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7280207W00000X, 2082S0099X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========Medicare ID - Type Unspecified