Provider Demographics
NPI:1275125239
Name:AUDITORY AND VESTIBULAR INSTITUTE OF NEW ENGLAND LLC,
Entity Type:Organization
Organization Name:AUDITORY AND VESTIBULAR INSTITUTE OF NEW ENGLAND LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-642-0367
Mailing Address - Street 1:21 APPLE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-3203
Mailing Address - Country:US
Mailing Address - Phone:845-642-0367
Mailing Address - Fax:
Practice Address - Street 1:3074 WHITNEY AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:475-227-0842
Practice Address - Fax:203-745-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty