Provider Demographics
NPI:1346459740
Name:EAR CARE HEARING AID CENTERS PINE BUSH
Entity Type:Organization
Organization Name:EAR CARE HEARING AID CENTERS PINE BUSH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-744-3355
Mailing Address - Street 1:6 BONIFACE DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566
Mailing Address - Country:US
Mailing Address - Phone:845-744-3355
Mailing Address - Fax:845-744-3351
Practice Address - Street 1:6 BONIFACE DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566
Practice Address - Country:US
Practice Address - Phone:845-744-3355
Practice Address - Fax:845-744-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000018982332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02660635Medicaid