Healthcare Provider Details

I. General information

NPI: 1841651866
Provider Name (Legal Business Name): SAM'S HEARING AID CENTER #6332
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FRANKLIN MILLS CIR
PHILADELPHIA PA
19154-3115
US

IV. Provider business mailing address

1000 FRANKLIN MILLS CIR
PHILADELPHIA PA
19154-3115
US

V. Phone/Fax

Practice location:
  • Phone: 215-613-1201
  • Fax:
Mailing address:
  • Phone: 215-613-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberF03577
License Number StatePA

VIII. Authorized Official

Name: ROBIN MICHAEL FARYNA
Title or Position: HEARING INSTRUMENT SPECIALIST
Credential: BC-HIS
Phone: 215-613-1201