Provider Demographics
NPI:1457557423
Name:NEW HAMPSHIRE HEARING AND BALANCE, LLC
Entity type:Organization
Organization Name:NEW HAMPSHIRE HEARING AND BALANCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:WOODIE
Authorized Official - Last Name:FODERO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:603-436-4655
Mailing Address - Street 1:655 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-2264
Mailing Address - Country:US
Mailing Address - Phone:603-436-4655
Mailing Address - Fax:
Practice Address - Street 1:655 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2264
Practice Address - Country:US
Practice Address - Phone:603-436-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251N0400X
NH167231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH040164Medicare ID - Type Unspecified