=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922305549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN COUNTY AUDIOLOGY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2011
-----------------------------------------------------
Last Update Date | 02/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74 E 9TH ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-1995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-817-5697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 E 9TH ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-1995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-817-5697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ADAM ENOCK
-----------------------------------------------------
Credential | SC.D.
-----------------------------------------------------
Telephone | 215-817-5697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 25MG00121500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------