Provider Demographics
NPI:1952802563
Name:HEARITE AUDIOLOGICAL CARE, PA
Entity Type:Organization
Organization Name:HEARITE AUDIOLOGICAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-737-9555
Mailing Address - Street 1:456 CHESTNUT ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6124
Mailing Address - Country:US
Mailing Address - Phone:732-737-9555
Mailing Address - Fax:
Practice Address - Street 1:456 CHESTNUT ST UNIT 302
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6124
Practice Address - Country:US
Practice Address - Phone:732-737-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1111332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0497479Medicaid