Healthcare Provider Details

I. General information

NPI: 1164089470
Provider Name (Legal Business Name): CWLJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 KIRKWOOD HWY STE 101
WILMINGTON DE
19808-5125
US

IV. Provider business mailing address

16 STEWART RD
PILESGROVE NJ
08098-3140
US

V. Phone/Fax

Practice location:
  • Phone: 800-508-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: WILSON HANNOLD III
Title or Position: OWNER
Credential:
Phone: 609-364-1212