Healthcare Provider Details

I. General information

NPI: 1376077560
Provider Name (Legal Business Name): TOMER BAHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAIN ST
STONEHAM MA
02180-1619
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 781-850-4020
  • Fax: 781-435-2608
Mailing address:
  • Phone: 732-529-7120
  • Fax: 732-568-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number443-HE-1
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: