Basic Information
| Provider Information | |||||||||
| NPI: | 1588129290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARING WHOLESALE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 556 MERRICK RD STE LL1 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115705546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165963277 | ||||||||
| FaxNumber: | 5165963270 | ||||||||
| Practice Location | |||||||||
| Address1: | 556 MERRICK RD STE LL1 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115705546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165963277 | ||||||||
| FaxNumber: | 5165963270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | BELLIA | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5165963277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1245625656 | 01 | NY | HEARING AID DISPENSER | OTHER |