Provider Demographics
NPI:1255431318
Name:INTERSTATE HEARING AID SERVICE, INC.
Entity type:Organization
Organization Name:INTERSTATE HEARING AID SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:TREGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-375-7591
Mailing Address - Street 1:45 LUDLOW ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:914-375-7591
Mailing Address - Fax:914-375-2994
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 602
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-375-7591
Practice Address - Fax:914-375-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000006959332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01786034Medicaid
NY01786034Medicaid