Provider Demographics
NPI:1124419577
Name:AUDIOLOGY & HEARING CENTERS OF NEPA, LLC
Entity Type:Organization
Organization Name:AUDIOLOGY & HEARING CENTERS OF NEPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISLUPSKI
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:570-383-0500
Mailing Address - Street 1:1339 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2055
Mailing Address - Country:US
Mailing Address - Phone:570-383-0500
Mailing Address - Fax:570-343-7734
Practice Address - Street 1:1339 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2055
Practice Address - Country:US
Practice Address - Phone:570-383-0500
Practice Address - Fax:570-343-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000012L231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007510830004Medicaid
PA30132OtherGEISINGER