=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205572492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GN HEARING CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2022
-----------------------------------------------------
Last Update Date | 06/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3860 MCKINLEY PKWY
-----------------------------------------------------
City | BLASDELL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14219-2983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-826-0850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 PATRIOT BLVD
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60026-8023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-832-3838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | MR. RONALD GLEITMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-832-3838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------