Provider Demographics
NPI:1417358557
Name:PORT TACK, LLC.
Entity Type:Organization
Organization Name:PORT TACK, LLC.
Other - Org Name:ZOUNDS JERSEY SHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-787-6367
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-1156
Mailing Address - Country:US
Mailing Address - Phone:281-787-6367
Mailing Address - Fax:405-603-2207
Practice Address - Street 1:1195 ROUTE 70
Practice Address - Street 2:UNIT 1007
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5946
Practice Address - Country:US
Practice Address - Phone:732-994-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment