Provider Demographics
NPI:1891092755
Name:AUDSLP DIAGNOSTIC AND REHABILITATION CLINIC
Entity Type:Organization
Organization Name:AUDSLP DIAGNOSTIC AND REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:973-903-9314
Mailing Address - Street 1:ONE BROADWAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-773-8962
Mailing Address - Fax:201-773-8963
Practice Address - Street 1:ONE BROADWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:201-773-8962
Practice Address - Fax:201-773-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center