Provider Demographics
NPI:1043589831
Name:ROBERT J. DENYSE, INC.
Entity Type:Organization
Organization Name:ROBERT J. DENYSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENYSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-426-3409
Mailing Address - Street 1:217 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3605
Mailing Address - Country:US
Mailing Address - Phone:260-426-3409
Mailing Address - Fax:260-426-0127
Practice Address - Street 1:217 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3605
Practice Address - Country:US
Practice Address - Phone:260-426-3409
Practice Address - Fax:260-426-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002372A332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200520080AMedicaid