Provider Demographics
NPI:1528230307
Name:NORTHEAST HEARING CENTER, INC.
Entity Type:Organization
Organization Name:NORTHEAST HEARING CENTER, INC.
Other - Org Name:NORTHEAST HEARING CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAFORGE
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOLOGIST
Authorized Official - Phone:954-491-3707
Mailing Address - Street 1:5333 N DIXIE HWY
Mailing Address - Street 2:#105
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3414
Mailing Address - Country:US
Mailing Address - Phone:954-491-3707
Mailing Address - Fax:954-491-1201
Practice Address - Street 1:5333 N DIXIE HWY
Practice Address - Street 2:#105
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3414
Practice Address - Country:US
Practice Address - Phone:954-491-3707
Practice Address - Fax:954-491-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6594Medicare UPIN