=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104647833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARING CARE CENTERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2024
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 97 SOUTH ST STE 101
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06110-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-247-7724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 97 SOUTH ST STE 101
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06110-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-247-7724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VINCENT DEGENNARO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-841-4749
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------