Healthcare Provider Details

I. General information

NPI: 1609030782
Provider Name (Legal Business Name): RAYMOND C WOITKOWSKI HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 YVONNE DR
DALTON MA
01226
US

IV. Provider business mailing address

86 YVONNE DR
DALTON MA
01226
US

V. Phone/Fax

Practice location:
  • Phone: 413-442-7284
  • Fax: 413-442-7284
Mailing address:
  • Phone: 413-442-7284
  • Fax: 413-442-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number251618
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number14000008903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: