Healthcare Provider Details

I. General information

NPI: 1306366018
Provider Name (Legal Business Name): AUDSTANDARD HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11625 QUEENS BLVD
FOREST HILLS NY
11375-6533
US

IV. Provider business mailing address

115 ROUTE 46 STE G51
MOUNTAIN LAKES NJ
07046-1676
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-0066
  • Fax: 718-261-0067
Mailing address:
  • Phone: 973-588-7266
  • Fax: 973-588-7268

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: JONATHAN WEIZMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 973-588-7266