Provider Demographics
NPI:1003168279
Name:A&E AUDIOLOGY AND HEARING AID CENTER
Entity Type:Organization
Organization Name:A&E AUDIOLOGY AND HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:717-627-4327
Mailing Address - Street 1:226 WILLOW VALLEY LAKES DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9665
Mailing Address - Country:US
Mailing Address - Phone:717-464-2144
Mailing Address - Fax:717-464-4255
Practice Address - Street 1:226 WILLOW VALLEY LAKES DR
Practice Address - Street 2:SUITE D
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9665
Practice Address - Country:US
Practice Address - Phone:717-464-2144
Practice Address - Fax:717-464-4255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A&E AUDIOLOGY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty