Provider Demographics
NPI:1598036303
Name:PROFESSIONAL HEARING SERVICE, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING SERVICE, LLC
Other - Org Name:BELTONE HEARING CARE AND AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-520-8536
Mailing Address - Street 1:17 E WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2207
Practice Address - Country:US
Practice Address - Phone:973-520-8536
Practice Address - Fax:973-520-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00045100237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0619400Medicaid