Provider Demographics
NPI:1689963530
Name:AUDIOLOGIC DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:AUDIOLOGIC DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:610-275-4151
Mailing Address - Street 1:306 WEST LOGAN STREET
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-2935
Mailing Address - Country:US
Mailing Address - Phone:610-275-4151
Mailing Address - Fax:610-278-7709
Practice Address - Street 1:306 W LOGAN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-2935
Practice Address - Country:US
Practice Address - Phone:610-275-4151
Practice Address - Fax:610-278-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0403332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment