Healthcare Provider Details

I. General information

NPI: 1972652964
Provider Name (Legal Business Name): ACOUSTICON HASKILL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST
HACKENSACK NJ
07601-5704
US

IV. Provider business mailing address

255 MAIN ST
HACKENSACK NJ
07601-5704
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1080
  • Fax: 201-342-3464
Mailing address:
  • Phone: 201-342-1080
  • Fax: 201-342-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number25MG00009300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number25MG00103800
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0781606
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. DAVID HASKILL
Title or Position: PRESIDENT
Credential:
Phone: 201-342-1080