Healthcare Provider Details

I. General information

NPI: 1952846420
Provider Name (Legal Business Name): IDEAL PRACTICE MANAGEMENT GROUP DE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 SURVEYOR CT STE 120
MANASSAS VA
20110-4408
US

IV. Provider business mailing address

35 WATERVIEW BLVD STE 305
PARSIPPANY NJ
07054-7604
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-0300
  • Fax:
Mailing address:
  • Phone: 603-288-3233
  • Fax: 973-588-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: VICKI COLE
Title or Position: CFO
Credential:
Phone: 973-588-7266