Basic Information
| Provider Information | |||||||||
| NPI: | 1609395235 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AUDIOLOGY DISTRIBUTION, LLC | ||||||||
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| OtherOrganizationName: | HEARUSA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 3298 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601323298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVER EDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076612011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012910550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2017 | ||||||||
| LastUpdateDate: | 09/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | GELATT | ||||||||
| AuthorizedOfficialFirstName: | MORGAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER OF INSURANCE CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 5614788770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.