MEDICARE: THE HEARING CENTER OF BRIDGEPORT, LLC

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	231HA2400X	Assistive Technology Practitioner Audiologist	000418	CT
2	231HA2500X	Assistive Technology Supplier Audiologist	000418	CT
3	237600000X	Audiologist-Hearing Aid Fitter	000418	CT
4	231H00000X	Audiologist	000418	CT

General Provider Information

NPI Number	:	1265765705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEARING CENTER OF BRIDGEPORT, LLC

Provider Business Mailing Address
First Line	:	515 N RIDGEFIELD AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-2557
Country	:	US
Telephone Number	:	203-330-9100
Fax Number	:	203-413-6482

Provider Business Practice Location Address
First Line	:	515 N RIDGEFIELD AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-2557
Country	:	US
Telephone Number	:	203-330-9100
Fax Number	:	203-413-6482

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. JAMES LEO
Credential	:
Telephone Number	:	203-243-4571

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	10/05/2009

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