Basic Information
Provider Information
NPI: 1245625656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELLIA
FirstName: ROBERT
MiddleName: A
NamePrefix:  
NameSuffix: JR.
Credential: HAD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2510 E SUNSET RD
Address2: UNIT 5-260
City: LAS VEGAS
State: NV
PostalCode: 891203511
CountryCode: US
TelephoneNumber: 7027980113
FaxNumber: 8662915242
Practice Location
Address1: 556 MERRICK RD
Address2: LL-1
City: ROCKVILLE CENTRE
State: NY
PostalCode: 115705487
CountryCode: US
TelephoneNumber: 5165963277
FaxNumber: 5165963270
Other Information
ProviderEnumerationDate: 04/02/2015
LastUpdateDate: 04/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X14000007388NYY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


Home