Provider Demographics
NPI:1104194174
Name:HOME HEARING CARE AUDIOLOGICAL SPECIALIST P C
Entity Type:Organization
Organization Name:HOME HEARING CARE AUDIOLOGICAL SPECIALIST P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-A
Authorized Official - Phone:631-207-1119
Mailing Address - Street 1:331 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3142
Mailing Address - Country:US
Mailing Address - Phone:631-207-1119
Mailing Address - Fax:631-207-2293
Practice Address - Street 1:331 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3142
Practice Address - Country:US
Practice Address - Phone:631-207-1119
Practice Address - Fax:631-207-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001056-1332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01332118Medicaid
NY01332118Medicaid