Provider Demographics
NPI:1619259116
Name:TRI STATE HEARING
Entity Type:Organization
Organization Name:TRI STATE HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMIANOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-362-0378
Mailing Address - Street 1:17 BREVOORT DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3063
Mailing Address - Country:US
Mailing Address - Phone:845-362-0378
Mailing Address - Fax:845-362-0378
Practice Address - Street 1:17 BREVOORT DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3063
Practice Address - Country:US
Practice Address - Phone:845-362-0378
Practice Address - Fax:845-362-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000001433332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment