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General NPI Number Information
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NPI Number | 1861722472
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Entity Type | Organization
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Legal Business Name | BROOKWAY LLC
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 11180 PEARL ROAD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3411
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Country | US
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Telephone | 440-572-9929
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Fax | 440-572-9928
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Provider Business Mailing Address
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Address Line | 11180 PEARL RD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3310
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Country | US
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Telephone | 440-572-9929
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Fax | 440-572-9928
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ROBERT ALAN PAVLIK JR.
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Credential | B.A., BC-HIS
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Telephone | 440-572-9929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 02668
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License Number State | OH
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