MEDICARE: MINDY NEUSTADT M.S.

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	237600000X	Audiologist-Hearing Aid Fitter	741	NJ

General Provider Information

NPI Number	:	1538347414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY NEUSTADT M.S.

Provider Business Mailing Address
First Line	:	1175 COUGHLIN ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5999
Country	:	US
Telephone Number	:	732-737-9555
Fax Number	:	732-737-9556

Provider Business Practice Location Address
First Line	:	456 CHESTNUT ST
Second Line	:	SUITE 303
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5811
Country	:	US
Telephone Number	:	732-737-9555
Fax Number	:	732-737-9556

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

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/23/2016

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