Healthcare Provider Details

I. General information

NPI: 1639178775
Provider Name (Legal Business Name): GARDEN STATE HEARING AND BALANCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 RTE 37 W
TOMS RIVER NJ
08755-8023
US

IV. Provider business mailing address

250 RTE 37 W
TOMS RIVER NJ
08755-8023
US

V. Phone/Fax

Practice location:
  • Phone: 732-818-3610
  • Fax: 732-818-3663
Mailing address:
  • Phone: 732-818-3610
  • Fax: 732-818-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00067800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number41YA00032200
License Number StateNJ

VIII. Authorized Official

Name: MR. ISIDORE MICHAEL KIRSH
Title or Position: PRESIDENT
Credential: PHD
Phone: 732-818-3610