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General NPI Number Information
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NPI Number | 1710167804
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Entity Type | Individual
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Provider Name | MR. KENNETH CHARLES PRUYN JR.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 67 FOREST ST STE 350-25
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3195
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Country | US
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Telephone | 508-794-3620
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Fax | 508-205-0291
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Provider Business Mailing Address
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Address Line | 20 BEAVER POND RD STE 201
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City | MILFORD
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State | MA
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Zip | 01757-3743
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Country | US
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Telephone | 508-794-3620
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Fax | 508-205-0291
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 254
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License Number State | MA
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