Provider Demographics
NPI:1700122017
Name:JOHN WEIGAND AUDIOLOGY PC
Entity Type:Organization
Organization Name:JOHN WEIGAND AUDIOLOGY PC
Other - Org Name:LIBERTY HEARING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNWER/AUD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIGAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-983-8918
Mailing Address - Street 1:445 LENOX RD
Mailing Address - Street 2:SUITE J BOX 1283
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2017
Mailing Address - Country:US
Mailing Address - Phone:347-983-8918
Mailing Address - Fax:914-668-4932
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:SUITE J BOX 1283
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:347-983-8918
Practice Address - Fax:914-668-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
NY0016191261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM73881OtherPTAN