MEDICARE: KRISTOFER MARIUS SUCH AUDIOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	41YA00139600	NJ

General Provider Information

NPI Number	:	1134074305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOFER MARIUS SUCH AUDIOLOGIST

Provider Business Mailing Address
First Line	:	40 STIRLING RD STE 206B
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-5900
Country	:	US
Telephone Number	:	908-756-5227
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 STIRLING RD STE 206B
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-5900
Country	:	US
Telephone Number	:	908-756-5227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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