Healthcare Provider Details

I. General information

NPI: 1710353859
Provider Name (Legal Business Name): JONATHAN BRITTIAN AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 W CHESTER PIKE STE 280 NEMOURS DUPONT PEDIATRICS, NEWTOWN SQUARE
NEWTOWN SQUARE PA
19073-2304
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPARTMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 610-557-4800
  • Fax: 610-557-4816
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberO20000215
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: