Provider Demographics
NPI:1093087967
Name:WATSON HEARING AID CENTER, LLC
Entity Type:Organization
Organization Name:WATSON HEARING AID CENTER, LLC
Other - Org Name:RIVERSIDE HEARING AID SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOPROTHOLOGIST-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:845-338-3934
Mailing Address - Street 1:1 ALBANY AVENUE
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2946
Mailing Address - Country:US
Mailing Address - Phone:845-338-3934
Mailing Address - Fax:845-338-3772
Practice Address - Street 1:1 ALBANY AVENUE
Practice Address - Street 2:SUITE G-1
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2946
Practice Address - Country:US
Practice Address - Phone:845-338-3934
Practice Address - Fax:845-338-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000004764237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty