Provider Demographics
NPI:1629419155
Name:GOTLIEB HEARING CENTER
Entity Type:Organization
Organization Name:GOTLIEB HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EREZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-703-6800
Mailing Address - Street 1:13-19 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-703-6800
Mailing Address - Fax:201-703-6805
Practice Address - Street 1:13-19 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-703-6800
Practice Address - Fax:201-703-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00002100231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6126600Medicaid
NJ6126600Medicaid