1215170220 NPI number — TETER AUDIOLOGY, HEARING AID DISPENSING AND ELECTRONICS, PC

Table of content: (NPI 1215170220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215170220 NPI number — TETER AUDIOLOGY, HEARING AID DISPENSING AND ELECTRONICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TETER AUDIOLOGY, HEARING AID DISPENSING AND ELECTRONICS, PC
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:
HEARCARE
Provider Other Organization Name Type Code:
3
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:
1215170220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 WILLOW POND WAY
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
PENFIELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14526-2687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-421-7039
Provider Business Mailing Address Fax Number:
585-388-1180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 WILLOW POND WAY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PENFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14526-2687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-421-7039
Provider Business Practice Location Address Fax Number:
585-388-1180
Provider Enumeration Date:
04/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TETER
Authorized Official First Name:
JARED
Authorized Official Middle Name:
GIFFORD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-421-7039

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  001959 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com