Basic Information
| Provider Information | |||||||||
| NPI: | 1891858577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEURO AUDIOLOGY CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7301A W PALMETTO PARK RD | ||||||||
| Address2: | SUITE 305A | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334333409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613936161 | ||||||||
| FaxNumber: | 5613935331 | ||||||||
| Practice Location | |||||||||
| Address1: | 7301A W PALMETTO PARK RD | ||||||||
| Address2: | SUITE 305A | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334333409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613936161 | ||||||||
| FaxNumber: | 5613935331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | LOCKER | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5613936161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MCD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY981 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | AY981 | 01 | STATE OF FLORIDA DEPT OF HEALTH | OTHER |