MEDICARE: NJ AUDIOLOGY GROUP INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1184357683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NJ AUDIOLOGY GROUP INC

Provider Business Mailing Address
First Line	:	8901 KENNEDY BLVD STE 4S
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5345
Country	:	US
Telephone Number	:	201-472-8500
Fax Number	:	201-472-8501

Provider Business Practice Location Address
First Line	:	8901 KENNEDY BLVD STE 4S
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5345
Country	:	US
Telephone Number	:	201-472-8500
Fax Number	:	201-472-8501

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PAM LONG
Credential	:
Telephone Number	:	201-472-8500

Provider Enumeration Date	:	07/03/2022
Last Update Date	:	02/12/2024

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