Healthcare Provider Details

I. General information

NPI: 1003991993
Provider Name (Legal Business Name): LARRY JAY DENENBERG MA CCC A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD YORK RD STE 104
JENKINTOWN PA
19046
US

IV. Provider business mailing address

500 OLD YORK RD STE 104
JENKINTOWN PA
19046
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-2268
  • Fax: 215-886-6016
Mailing address:
  • Phone: 215-886-2268
  • Fax: 215-886-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000357L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: