Provider Demographics
NPI:1760608152
Name:AUDIOLOGY AND HEARING AID SERVICES, INC
Entity Type:Organization
Organization Name:AUDIOLOGY AND HEARING AID SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-A
Authorized Official - Phone:304-345-8522
Mailing Address - Street 1:2205 WASHINGTON ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2218
Mailing Address - Country:US
Mailing Address - Phone:304-345-8522
Mailing Address - Fax:304-344-5305
Practice Address - Street 1:2205 WASHINGTON ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2218
Practice Address - Country:US
Practice Address - Phone:304-345-8522
Practice Address - Fax:304-344-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1022588OtherWORKER'S COMPENSATION
WV4000074000Medicaid