Provider Demographics
NPI:1639447865
Name:SALVESEN, MARK PETER (BC-HIS NJ HEARING AI)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:PETER
Last Name:SALVESEN
Suffix:
Gender:M
Credentials:BC-HIS NJ HEARING AI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-343-1980
Mailing Address - Fax:201-343-6323
Practice Address - Street 1:681 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-343-1980
Practice Address - Fax:201-343-6323
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ535237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist