Provider Demographics
NPI:1467602813
Name:BROOKLANDS AUDIOLOGY, INC
Entity Type:Organization
Organization Name:BROOKLANDS AUDIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA A.
Authorized Official - Middle Name:A
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC
Authorized Official - Phone:610-408-9250
Mailing Address - Street 1:9 OLD LINCOLN HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2551
Mailing Address - Country:US
Mailing Address - Phone:610-408-9250
Mailing Address - Fax:
Practice Address - Street 1:9 OLD LINCOLN HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2551
Practice Address - Country:US
Practice Address - Phone:610-408-9250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000887L231HA2500X, 261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACO046406Medicare PIN