Provider Demographics
NPI:1205193703
Name:ACOUSTICARE HEARING AND AUDIOLOGY
Entity Type:Organization
Organization Name:ACOUSTICARE HEARING AND AUDIOLOGY
Other - Org Name:DR MICHAEL PENGELLY AUD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PENGELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF AUDIOLOGY
Authorized Official - Phone:610-216-4977
Mailing Address - Street 1:3935 HIGHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9680
Mailing Address - Country:US
Mailing Address - Phone:610-216-4977
Mailing Address - Fax:610-965-0859
Practice Address - Street 1:1011 BROOKSIDE RD STE 260
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9021
Practice Address - Country:US
Practice Address - Phone:610-216-4977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT00219261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06705Medicare UPIN