Healthcare Provider Details

I. General information

NPI: 1790804904
Provider Name (Legal Business Name): 21ST CENTURY HEARING CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 MAIN ST
HACKENSACK NJ
07601-7302
US

IV. Provider business mailing address

183 MAIN ST
HACKENSACK NJ
07601-7302
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-8181
  • Fax: 201-203-2083
Mailing address:
  • Phone: 201-343-8181
  • Fax: 201-203-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number25MG00067200
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOANNE SALVESEN
Title or Position: MEMBER
Credential:
Phone: 201-405-1480