Provider Demographics
NPI:1033278239
Name:JAMIE LANTZ, LLC
Entity Type:Organization
Organization Name:JAMIE LANTZ, LLC
Other - Org Name:PROFESSIONAL HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:732-303-9660
Mailing Address - Street 1:4257 US HIGHWAY 9 BLDG 6
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8310
Mailing Address - Country:US
Mailing Address - Phone:732-303-9660
Mailing Address - Fax:732-303-1810
Practice Address - Street 1:4257 US HIGHWAY 9 BLDG 6
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8310
Practice Address - Country:US
Practice Address - Phone:732-303-9660
Practice Address - Fax:732-303-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7939809Medicaid
NJ7939809Medicaid