Provider Demographics
NPI:1952451502
Name:AUDIOLOGY & HEARING CENTERS OF NEPA, LLC
Entity Type:Organization
Organization Name:AUDIOLOGY & HEARING CENTERS OF NEPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISLUPSKI
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:570-822-6122
Mailing Address - Street 1:34 S MAIN ST
Mailing Address - Street 2:PROVINCIAL TOWER - MAIN FLOOR
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1723
Mailing Address - Country:US
Mailing Address - Phone:570-822-6122
Mailing Address - Fax:570-822-7809
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:PROVINCIAL TOWER - MAIN FLOOR
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1723
Practice Address - Country:US
Practice Address - Phone:570-822-6122
Practice Address - Fax:570-822-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000012L332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019075890003Medicaid
PA1007510830004Medicaid
PA019076310001Medicaid
PA30132OtherGEISINGER