Provider Demographics
NPI:1972540748
Name:WEST NEWTON HEARING CENTER, LLC
Entity Type:Organization
Organization Name:WEST NEWTON HEARING CENTER, LLC
Other - Org Name:WEST NEWTON HEARING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:617-332-7244
Mailing Address - Street 1:1298 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465
Mailing Address - Country:US
Mailing Address - Phone:617-332-7244
Mailing Address - Fax:617-630-8244
Practice Address - Street 1:1298 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465
Practice Address - Country:US
Practice Address - Phone:617-332-7244
Practice Address - Fax:617-630-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
MA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
605850OtherHCHP
AG0002OtherBLUE CROSS BLUE SHIELD
702568OtherTUFTS
AG0002OtherBLUE CROSS BLUE SHIELD