Provider Demographics
NPI:1508908435
Name:SUSSEX AUDIOLOGY SERVICES AND HEARING AID CENTER, LLC
Entity Type:Organization
Organization Name:SUSSEX AUDIOLOGY SERVICES AND HEARING AID CENTER, LLC
Other - Org Name:ELIZABETH M. CHIUSANO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CHIUSANO
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:973-383-4100
Mailing Address - Street 1:20 GOODALE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2782
Mailing Address - Country:US
Mailing Address - Phone:973-579-3791
Mailing Address - Fax:973-579-3984
Practice Address - Street 1:39 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2773
Practice Address - Country:US
Practice Address - Phone:973-383-4100
Practice Address - Fax:973-383-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00061500231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTRICARE PRACTICE ID