Healthcare Provider Details

I. General information

NPI: 1073970067
Provider Name (Legal Business Name): HEARITE AUDIOLOGICAL CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 CHESTNUT ST SUITE 303
LAKEWOOD NJ
08701-5811
US

IV. Provider business mailing address

1175 COUGHLIN ST
LAKEWOOD NJ
08701-5999
US

V. Phone/Fax

Practice location:
  • Phone: 732-937-9555
  • Fax:
Mailing address:
  • Phone: 732-737-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1111
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number741
License Number StateNJ

VIII. Authorized Official

Name: MINDY NEUSTADT
Title or Position: OWNER
Credential: M.S.
Phone: 732-737-9555