Healthcare Provider Details

I. General information

NPI: 1598168577
Provider Name (Legal Business Name): SOPHISTICATED HEARING AIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N FRANKLIN TPKE STE B1
HO HO KUS NJ
07423-1562
US

IV. Provider business mailing address

50 N FRANKLIN TPKE STE B1
HO HO KUS NJ
07423-1562
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2455
  • Fax:
Mailing address:
  • Phone: 201-445-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00082000
License Number StateNJ

VIII. Authorized Official

Name: DR. ANN MARIE OLSON
Title or Position: OWNER, AUDIOLOGIST
Credential: SCD
Phone: 201-445-2455