Healthcare Provider Details

I. General information

NPI: 1629419155
Provider Name (Legal Business Name): GOTLIEB HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13-19 RIVER ROAD
FAIR LAWN NJ
07410
US

IV. Provider business mailing address

13-19 RIVER ROAD
FAIR LAWN NJ
07410
US

V. Phone/Fax

Practice location:
  • Phone: 201-703-6800
  • Fax: 201-703-6805
Mailing address:
  • Phone: 201-703-6800
  • Fax: 201-703-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00002100
License Number StateNJ

VIII. Authorized Official

Name: EREZ GOTLIEB
Title or Position: MANAGER
Credential:
Phone: 201-703-6800