=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518355866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCONSOUTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2015
-----------------------------------------------------
Last Update Date | 01/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5030 CHAMPION BLVD SUITE G12
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33496-2473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-288-1610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 FIFTH AVE 5E SOUTH
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-959-1801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | ROBYN BARSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-959-1801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 201469577
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------