Healthcare Provider Details

I. General information

NPI: 1750634077
Provider Name (Legal Business Name): COTTAGE GROVE AUDIOLOGY & HEARING AIDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTHWESTERN DR
BLOOMFIELD CT
06002-3444
US

IV. Provider business mailing address

4 NORTHWESTERN DR
BLOOMFIELD CT
06002-3444
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-9510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALAN NEEDHAM
Title or Position: OWNER
Credential:
Phone: 860-243-9510