Healthcare Provider Details

I. General information

NPI: 1710426051
Provider Name (Legal Business Name): MILLBURN AUDIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WILLOW ST SUITE B
MILLBURN NJ
07041-1416
US

IV. Provider business mailing address

25 E WILLOW ST SUITE B
MILLBURN NJ
07041-1416
US

V. Phone/Fax

Practice location:
  • Phone: 973-564-8890
  • Fax: 847-886-7525
Mailing address:
  • Phone: 973-564-8890
  • Fax: 847-886-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAIME R TAYLOR
Title or Position: OWNER
Credential: AU.D
Phone: 973-564-8890