Healthcare Provider Details

I. General information

NPI: 1306077276
Provider Name (Legal Business Name): MASS AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 COTTONTAIL LN STE 101
SOMERSET NJ
08873-5125
US

IV. Provider business mailing address

2501 COTTONTAIL LN STE 101
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 732-529-7151
  • Fax: 732-568-7742
Mailing address:
  • Phone: 732-529-7151
  • Fax: 732-568-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVE DUTSON
Title or Position: V.P. ACCOUNTING
Credential:
Phone: 732-564-7115