=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821594144
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARINGLIFE HEARING AID CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2018
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14911 NATIONAL AVE STE 2
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-857-7487
-----------------------------------------------------
Fax | 732-960-6181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 COTTONTAIL LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-5125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-529-7120
-----------------------------------------------------
Fax | 732-960-6181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, REV CYCLE & PAYER RELATIONS
-----------------------------------------------------
Name | BAHAR BAZMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-260-1504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------