1245383421 NPI number — TOTAL HEARING CARE, LLC

Table of content: (NPI 1245383421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245383421 NPI number — TOTAL HEARING CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL HEARING CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245383421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 COTTONTAIL LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-5125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-529-7120
Provider Business Mailing Address Fax Number:
973-226-6700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 EAGLE ROCK AVENUE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ROSELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07068-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-226-6700
Provider Business Practice Location Address Fax Number:
973-226-6722
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRAUN
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
847-722-1543

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 007616 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044539 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044946 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0058581 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044717 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0123102 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044679 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044725 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0047074 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0065021 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8293007 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044695 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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