Healthcare Provider Details

I. General information

NPI: 1851859078
Provider Name (Legal Business Name): MICHAEL NOGUEIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 HANOVER ST
FALL RIVER MA
02720-3742
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-5461
  • Fax:
Mailing address:
  • Phone: 732-529-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number471-HE-1
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: