Healthcare Provider Details

I. General information

NPI: 1174825137
Provider Name (Legal Business Name): RARITAN VALLEY AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 UNION AVE SUITE C
BRIDGEWATER NJ
08807-3063
US

IV. Provider business mailing address

215 UNION AVE SUITE C
BRIDGEWATER NJ
08807-3063
US

V. Phone/Fax

Practice location:
  • Phone: 908-248-4327
  • Fax: 908-573-5773
Mailing address:
  • Phone: 908-248-4327
  • Fax: 908-573-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00078100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1155
License Number StateNJ

VIII. Authorized Official

Name: FARAH M HUSSAIN-SAID
Title or Position: PRESIDENT
Credential: AUDIO
Phone: 908-248-4327