Provider Demographics
NPI:1396043899
Name:ADVANCED AUDIOLOGY GROUP, INC.
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-559-4327
Mailing Address - Street 1:3917 OLD LEE HWY
Mailing Address - Street 2:SUITE 11-B
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2431
Mailing Address - Country:US
Mailing Address - Phone:888-559-4327
Mailing Address - Fax:
Practice Address - Street 1:3917 OLD LEE HWY
Practice Address - Street 2:SUITE 11-B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2431
Practice Address - Country:US
Practice Address - Phone:888-559-4327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty