1366795460 NPI number — UNIVERSAL HEARING LLC

Table of content: (NPI 1366795460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366795460 NPI number — UNIVERSAL HEARING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL HEARING 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:
MIRACLE EAR
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:
1366795460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 ENTERPRISE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12095-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-353-4174
Provider Business Mailing Address Fax Number:
401-488-5774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 CEDAR LN
Provider Second Line Business Practice Location Address:
D2
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-530-7533
Provider Business Practice Location Address Fax Number:
201-530-7534
Provider Enumeration Date:
10/26/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARANDO
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
HEARING INSTRUMENT SPECIALIST
Authorized Official Telephone Number:
201-530-7533

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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