Healthcare Provider Details

I. General information

NPI: 1801174248
Provider Name (Legal Business Name): STEPHANIE LURIE ROGERS H.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ROUTE 70 E
CHERRY HILL NJ
08003-2118
US

IV. Provider business mailing address

1924 ROUTE 70 E
CHERRY HILL NJ
08003-2118
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-2212
  • Fax:
Mailing address:
  • Phone: 856-424-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00114000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: