Provider Demographics
NPI:1821260548
Name:CRANBERRY HEARING AND BALANCE CENTER, LLC
Entity Type:Organization
Organization Name:CRANBERRY HEARING AND BALANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUSTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-779-4444
Mailing Address - Street 1:20820 ROUTE 19 STE A
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6006
Mailing Address - Country:US
Mailing Address - Phone:724-779-4444
Mailing Address - Fax:
Practice Address - Street 1:20820 ROUTE 19 STE A
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6006
Practice Address - Country:US
Practice Address - Phone:724-779-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005835237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty