Basic Information
| Provider Information | |||||||||
| NPI: | 1205956331 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JENKINTOWN HEARING AID CENTER INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 500 YORK RD | ||||||||
| Address2: | STE. 104 | ||||||||
| City: | JENKINTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190462852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158862268 | ||||||||
| FaxNumber: | 2158866016 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 YORK RD | ||||||||
| Address2: | STE. 104 | ||||||||
| City: | JENKINTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190462852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158862268 | ||||||||
| FaxNumber: | 2158866016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RYAN | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES. | ||||||||
| AuthorizedOfficialTelephone: | 2158862268 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | B.C.-H.I.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 2060 | PA | Y | Suppliers | Hearing Aid Equipment |
No ID Information.