MEDICARE: HEARITE AUDIOLOGICAL CARE, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment	1111	NJ
2	237600000X	Audiologist-Hearing Aid Fitter	741	NJ

General Provider Information

NPI Number	:	1073970067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARITE AUDIOLOGICAL CARE, PA

Provider Business Mailing Address
First Line	:	1175 COUGHLIN ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5999
Country	:	US
Telephone Number	:	732-737-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 CHESTNUT ST
Second Line	:	SUITE 303
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5811
Country	:	US
Telephone Number	:	732-937-9555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MINDY NEUSTADT
Credential	:	M.S.
Telephone Number	:	732-737-9555

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	03/01/2018

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