Provider Demographics
NPI:1043791098
Name:MJD HEARING AID CENTER
Entity Type:Organization
Organization Name:MJD HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD-CERTIFIED HEARING INSTRUMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DION
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:603-548-7155
Mailing Address - Street 1:100 N POLICY ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-5906
Mailing Address - Country:US
Mailing Address - Phone:603-548-7155
Mailing Address - Fax:
Practice Address - Street 1:100 N POLICY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-5906
Practice Address - Country:US
Practice Address - Phone:603-548-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH-116237700000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1326361700Medicaid