Healthcare Provider Details

I. General information

NPI: 1750546842
Provider Name (Legal Business Name): FIDELITY HEARING HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 NORTH ST
SUMMIT NJ
07901-3982
US

IV. Provider business mailing address

18 NORTH ST
SUMMIT NJ
07901-3982
US

V. Phone/Fax

Practice location:
  • Phone: 973-641-1901
  • Fax:
Mailing address:
  • Phone: 973-641-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number41YA00057100
License Number StateNJ

VIII. Authorized Official

Name: MR. ALAN DAVID GROSS
Title or Position: OWNER
Credential: M.A., CCC
Phone: 973-641-1901