Provider Demographics
NPI:1598167025
Name:PETRUSO HEARING AND AUDIOLOGY
Entity Type:Organization
Organization Name:PETRUSO HEARING AND AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUSO
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:800-475-9192
Mailing Address - Street 1:937 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:800-475-9192
Mailing Address - Fax:
Practice Address - Street 1:51342 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:ST. CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-699-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETRUSO HEARING AND AUDIOLOGY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03222237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty