Healthcare Provider Details

I. General information

NPI: 1508921701
Provider Name (Legal Business Name): ASSOCIATED AUDIOLOGIC CONSULTANTS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 CHESTNUT ST SUITE 200
PHILADELPHIA PA
19103-4634
US

IV. Provider business mailing address

1920 CHESTNUT ST SUITE 200
PHILADELPHIA PA
19103-4634
US

V. Phone/Fax

Practice location:
  • Phone: 215-561-0550
  • Fax: 215-561-1235
Mailing address:
  • Phone: 215-561-0550
  • Fax: 215-561-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number41YA00045200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000228L
License Number StatePA

VIII. Authorized Official

Name: MR. EDWARD W KEELS
Title or Position: CEO
Credential: MACCCA
Phone: 215-561-0550