Provider Demographics
NPI:1932481058
Name:JACKSON AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:JACKSON AUDIOLOGY, LLC
Other - Org Name:FAMILY HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:609-895-1666
Mailing Address - Street 1:177 FRANKLIN CORNER RD
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2548
Mailing Address - Country:US
Mailing Address - Phone:609-895-1666
Mailing Address - Fax:609-895-1660
Practice Address - Street 1:177 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2548
Practice Address - Country:US
Practice Address - Phone:609-895-1666
Practice Address - Fax:609-895-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00077300261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12225842OtherCAQH