=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538795786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY G ALBANESE BC-HIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2020
-----------------------------------------------------
Last Update Date | 03/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 653 ROUTE 46 W
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07004-1589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-818-2025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 653 ROUTE 46 W
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07004-1589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-818-2025
-----------------------------------------------------
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 | 14000028100
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 1136
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------