Healthcare Provider Details

I. General information

NPI: 1386334233
Provider Name (Legal Business Name): ROBERT J DENYSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E. WASHINGTON BLVD. SUITE G
FOR WAYNE IN
46802-3100
US

IV. Provider business mailing address

333 E. WASHINGTON BLVD. SUITE G
FOR WAYNE IN
46802-3100
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-3409
  • Fax: 260-426-0127
Mailing address:
  • Phone: 260-426-3409
  • Fax: 260-426-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JORDAN DENYSE
Title or Position: AUDIOLOGIST
Credential:
Phone: 260-426-3409