MEDICARE: INTERSTATE HEARING AID SERVICE, 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	332S00000X	Hearing Aid Equipment	15000006959	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255431318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERSTATE HEARING AID SERVICE, INC.

Provider Business Mailing Address
First Line	:	45 LUDLOW ST
Second Line	:	SUITE 602
City	:	YONKERS
State	:	NY
Zip	:	10705-1947
Country	:	US
Telephone Number	:	914-375-7591
Fax Number	:	914-375-2994

Provider Business Practice Location Address
First Line	:	45 LUDLOW ST
Second Line	:	SUITE 602
City	:	YONKERS
State	:	NY
Zip	:	10705-1947
Country	:	US
Telephone Number	:	914-375-7591
Fax Number	:	914-375-2994

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN H TREGLIA
Credential	:
Telephone Number	:	914-375-7591

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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