Provider Demographics
NPI:1710426051
Name:MILLBURN AUDIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MILLBURN AUDIOLOGY ASSOCIATES LLC
Other - Org Name:MILLBURN AUDIOLOGY AND BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:973-564-8890
Mailing Address - Street 1:25 E WILLOW ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1416
Mailing Address - Country:US
Mailing Address - Phone:973-564-8890
Mailing Address - Fax:847-886-7525
Practice Address - Street 1:25 E WILLOW ST
Practice Address - Street 2:SUITE B
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1416
Practice Address - Country:US
Practice Address - Phone:973-564-8890
Practice Address - Fax:847-886-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ356627ZB6UMedicare PIN