Provider Demographics
NPI:1619010733
Name:R. W. PETRUSO HEARING AND AUDIOLOGY CENTER, INC
Entity Type:Organization
Organization Name:R. W. PETRUSO HEARING AND AUDIOLOGY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PETRUSO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:814-724-6211
Mailing Address - Street 1:937 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3334
Mailing Address - Country:US
Mailing Address - Phone:814-724-6211
Mailing Address - Fax:
Practice Address - Street 1:937 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3334
Practice Address - Country:US
Practice Address - Phone:814-724-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02763332S00000X
PAFO2267332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment