Healthcare Provider Details

I. General information

NPI: 1881884237
Provider Name (Legal Business Name): MAURA COSTA BRANCO BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAURA COSTA BRANCO BC-HIS

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 KEARNY AVE
KEARNY NJ
07032-2437
US

IV. Provider business mailing address

179 KEARNY AVE
KEARNY NJ
07032-2437
US

V. Phone/Fax

Practice location:
  • Phone: 201-428-9242
  • Fax: 201-428-9244
Mailing address:
  • Phone: 201-428-9242
  • Fax: 201-428-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number25MG00111200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: