Healthcare Provider Details

I. General information

NPI: 1013109529
Provider Name (Legal Business Name): MEDICAL HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 QUINEBAUG AVE
PUTNAM CT
06260-1943
US

IV. Provider business mailing address

PO BOX 514 19 QUINEBAUG AVE
PUTNAM CT
06260-0514
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-7793
  • Fax: 860-928-9760
Mailing address:
  • Phone: 860-928-7793
  • Fax: 860-928-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number000237
License Number StateCT

VIII. Authorized Official

Name: DR. NERI HOLZER
Title or Position: OWNER
Credential: MD
Phone: 860-928-7793