Provider Demographics
NPI:1659982403
Name:ADVANCE AUDIOLOGY CARE
Entity Type:Organization
Organization Name:ADVANCE AUDIOLOGY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:516-314-0988
Mailing Address - Street 1:200 PERRINE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2836
Mailing Address - Country:US
Mailing Address - Phone:516-314-0988
Mailing Address - Fax:908-935-0574
Practice Address - Street 1:200 PERRINE RD STE 210
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2836
Practice Address - Country:US
Practice Address - Phone:516-314-0988
Practice Address - Fax:908-935-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty