Provider Demographics
NPI:1578750543
Name:RANDOLPH FAMILY HEARING CENTER
Entity Type:Organization
Organization Name:RANDOLPH FAMILY HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/AUDIOLOGY & HEARING AIDS
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MMSC,
Authorized Official - Phone:973-366-6186
Mailing Address - Street 1:447 STATE ROUTE 10 STE 1
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2132
Mailing Address - Country:US
Mailing Address - Phone:973-366-6186
Mailing Address - Fax:
Practice Address - Street 1:447 STATE ROUTE 10 STE 1
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2132
Practice Address - Country:US
Practice Address - Phone:973-366-6186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3475301Medicaid
NJ3475301Medicaid