MEDICARE: JOHN DESIMONE HIS

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	237700000X	Hearing Instrument Specialist	F03645	PA

General Provider Information

NPI Number	:	1336681022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DESIMONE HIS

Provider Business Mailing Address
First Line	:	1603 COVENTRY LN
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-9430
Country	:	US
Telephone Number	:	610-202-0377
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W CHESTER PIKE
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-4400
Country	:	US
Telephone Number	:	484-455-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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Directions to “ JOHN DESIMONE HIS” Practice Location

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