Provider Demographics
NPI:1265920433
Name:ROSENBERG AUDIOLOGY INC.
Entity type:Organization
Organization Name:ROSENBERG AUDIOLOGY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:516-298-8765
Mailing Address - Street 1:246 BUNKER HILL ST # 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1828
Mailing Address - Country:US
Mailing Address - Phone:516-298-8765
Mailing Address - Fax:
Practice Address - Street 1:90 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4046
Practice Address - Country:US
Practice Address - Phone:516-298-8765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9872355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========Medicaid