Healthcare Provider Details

I. General information

NPI: 1366598187
Provider Name (Legal Business Name): NORTH SHORE HEARING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 MERRIMACK ST
HAVERHILL MA
01830-6128
US

IV. Provider business mailing address

192 MERRIMACK ST
HAVERHILL MA
01830-6128
US

V. Phone/Fax

Practice location:
  • Phone: 978-372-1939
  • Fax:
Mailing address:
  • Phone: 978-372-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number24W
License Number StateMA

VIII. Authorized Official

Name: CHARLES J ELIA
Title or Position: OWNER
Credential: MA
Phone: 978-462-9628