Healthcare Provider Details

I. General information

NPI: 1609395235
Provider Name (Legal Business Name): AUDIOLOGY DISTRIBUTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MAIN ST
RIVER EDGE NJ
07661-2011
US

IV. Provider business mailing address

DEPT 3298
CAROL STREAM IL
60132-3298
US

V. Phone/Fax

Practice location:
  • Phone: 201-291-0550
  • Fax:
Mailing address:
  • Phone: 561-478-8770
  • Fax: 561-598-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MORGAN GELATT
Title or Position: MANAGER OF INSURANCE CONTRACTING
Credential:
Phone: 561-478-8770