Provider Demographics
NPI:1093144792
Name:BOULEVARD HEARING AID CENTER
Entity Type:Organization
Organization Name:BOULEVARD HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:718-261-0066
Mailing Address - Street 1:11625 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6533
Mailing Address - Country:US
Mailing Address - Phone:718-261-0066
Mailing Address - Fax:718-261-0067
Practice Address - Street 1:11625 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6533
Practice Address - Country:US
Practice Address - Phone:718-261-0066
Practice Address - Fax:718-261-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000142-1332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment