Provider Demographics
NPI:1508113556
Name:AUDIOLOGY DISTRIBUTION, LLC
Entity type:Organization
Organization Name:AUDIOLOGY DISTRIBUTION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-478-8770
Mailing Address - Street 1:3298 DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:UNIT A11
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5733
Practice Address - Country:US
Practice Address - Phone:561-478-8770
Practice Address - Fax:561-598-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty