Healthcare Provider Details

I. General information

NPI: 1083645543
Provider Name (Legal Business Name): CERTIFIED AUDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD SUITE 301
LINWOOD NJ
08221-1299
US

IV. Provider business mailing address

222 NEW ROAD SUITE 301
LINWOOD NJ
08221-1299
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-0700
  • Fax: 609-926-4870
Mailing address:
  • Phone: 609-926-0700
  • Fax: 609-926-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00064200
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID R WEESNER
Title or Position: OWNER/AUDIOLOGIST/HEARING AID DISP
Credential: AU.D.
Phone: 609-926-0700