Healthcare Provider Details

I. General information

NPI: 1023353000
Provider Name (Legal Business Name): PEGGY J CANNATA-STANLICK NJ HEARING AID DISPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 MAIN ST
HACKENSACK NJ
07601-4713
US

IV. Provider business mailing address

681 MAIN ST
HACKENSACK NJ
07601-4713
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-1980
  • Fax: 201-343-6323
Mailing address:
  • Phone: 201-343-1980
  • Fax: 201-343-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number25MG00108600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: