Provider Demographics
NPI:1578158226
Name:NORTHEAST AUDIOLOGY LLC
Entity Type:Organization
Organization Name:NORTHEAST AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:603-742-6555
Mailing Address - Street 1:8 OLDENBURG LN
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869-5913
Mailing Address - Country:US
Mailing Address - Phone:603-923-3151
Mailing Address - Fax:
Practice Address - Street 1:158 NH ROUTE 108 STE G
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-8812
Practice Address - Country:US
Practice Address - Phone:603-742-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30432497Medicaid