Provider Demographics
NPI:1851594337
Name:MONTCLAIR HEARING AID CENTER DIV OF MICRO INSTRUMENTS, INC
Entity Type:Organization
Organization Name:MONTCLAIR HEARING AID CENTER DIV OF MICRO INSTRUMENTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS, ACA
Authorized Official - Phone:973-744-2466
Mailing Address - Street 1:500 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1853
Mailing Address - Country:US
Mailing Address - Phone:973-744-2466
Mailing Address - Fax:973-746-3120
Practice Address - Street 1:500 VALLEY RD
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1853
Practice Address - Country:US
Practice Address - Phone:973-744-2466
Practice Address - Fax:973-746-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ339672006332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2601508Medicaid