Healthcare Provider Details

I. General information

NPI: 1679861546
Provider Name (Legal Business Name): NEW ENGLAND AUDIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PILLSBURY ST
CONCORD NH
03301-3556
US

IV. Provider business mailing address

1 PILLSBURY ST
CONCORD NH
03301-3556
US

V. Phone/Fax

Practice location:
  • Phone: 603-856-8275
  • Fax: 603-219-0454
Mailing address:
  • Phone: 603-856-8275
  • Fax: 603-219-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA598
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: DAVID A JACQUES
Title or Position: MANAGER
Credential:
Phone: 603-856-8275