Provider Demographics
NPI:1639178775
Name:GARDEN STATE HEARING AND BALANCE CENTER, INC
Entity Type:Organization
Organization Name:GARDEN STATE HEARING AND BALANCE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISIDORE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-818-3610
Mailing Address - Street 1:250 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8023
Mailing Address - Country:US
Mailing Address - Phone:732-818-3610
Mailing Address - Fax:732-818-3663
Practice Address - Street 1:250 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8023
Practice Address - Country:US
Practice Address - Phone:732-818-3610
Practice Address - Fax:732-818-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00032200237600000X
NJ25MG00067800237600000X
261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0465611000OtherAMERIHEALTH GROUP
NJ0465611000OtherAMERIHEALTH GROUP