Provider Demographics
NPI:1174656631
Name:INNOVATIVE HEARING TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEARING TECHNOLOGIES, LLC
Other - Org Name:AUDIOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DELFINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-972-3076
Mailing Address - Street 1:111 S SPRUCE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2155
Mailing Address - Country:US
Mailing Address - Phone:610-694-0141
Mailing Address - Fax:610-759-2181
Practice Address - Street 1:1415 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9168
Practice Address - Country:US
Practice Address - Phone:610-694-0141
Practice Address - Fax:610-317-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000421L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7319052OtherAETNA
PA50005059OtherCAPITAL BLUE CROSS
PA085465Medicare ID - Type Unspecified