Healthcare Provider Details

I. General information

NPI: 1629469721
Provider Name (Legal Business Name): HEAR AT HOME NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CRAIG RD SUITE 205
MANALAPAN NJ
07726-8742
US

IV. Provider business mailing address

45 MEADOWLANDS PKWY UNIT 126
SECAUCUS NJ
07094-2927
US

V. Phone/Fax

Practice location:
  • Phone: 908-216-1761
  • Fax:
Mailing address:
  • Phone: 908-216-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number25MG00126500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number41YA00079600
License Number StateNJ

VIII. Authorized Official

Name: DR. JUSTIN LIPP
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 908-216-1761