Provider Demographics
NPI:1750546842
Name:FIDELITY HEARING HEALTH, LLC
Entity type:Organization
Organization Name:FIDELITY HEARING HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC
Authorized Official - Phone:973-641-1901
Mailing Address - Street 1:18 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3982
Mailing Address - Country:US
Mailing Address - Phone:973-641-1901
Mailing Address - Fax:
Practice Address - Street 1:18 NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3982
Practice Address - Country:US
Practice Address - Phone:973-641-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00057100237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty