Healthcare Provider Details

I. General information

NPI: 1265765705
Provider Name (Legal Business Name): THE HEARING CENTER OF BRIDGEPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N RIDGEFIELD AVE
BRIDGEPORT CT
06610-2557
US

IV. Provider business mailing address

515 N RIDGEFIELD AVE
BRIDGEPORT CT
06610-2557
US

V. Phone/Fax

Practice location:
  • Phone: 203-330-9100
  • Fax: 203-413-6482
Mailing address:
  • Phone: 203-330-9100
  • Fax: 203-413-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000418
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number000418
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number000418
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number000418
License Number StateCT

VIII. Authorized Official

Name: MR. JAMES LEO
Title or Position: GENERAL MANAGER
Credential:
Phone: 203-243-4571