Provider Demographics
NPI:1144243163
Name:NORTH SHORE AUDIOVESTIBULAR LAB INC
Entity Type:Organization
Organization Name:NORTH SHORE AUDIOVESTIBULAR LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:847-432-5555
Mailing Address - Street 1:1160 PARK AVE W
Mailing Address - Street 2:SUITE 4 SOUTH
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2230
Mailing Address - Country:US
Mailing Address - Phone:847-432-5555
Mailing Address - Fax:847-432-5554
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:SUITE 4 SOUTH
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2271
Practice Address - Country:US
Practice Address - Phone:847-432-5555
Practice Address - Fax:847-432-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL308200Medicare ID - Type Unspecified