=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134578081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JARED A TALARICO BC-HIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2016
-----------------------------------------------------
Last Update Date | 06/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 CLIFTON AVE SUITE 102
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-777-5335
-----------------------------------------------------
Fax | 973-777-3348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 SIMONSON CT
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-285-6560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 1244
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------