MEDICARE: AUDIOLOGY DISTRIBUTION, 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	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1528315579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY DISTRIBUTION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 200132
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-0021
Country	:	US
Telephone Number	:	561-530-2149
Fax Number	:	561-530-2149

Provider Business Practice Location Address
First Line	:	7401 BERGENLINE AVE STE 3
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5438
Country	:	US
Telephone Number	:	561-478-8770
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING ADMINISTRATOR
Name	:	JORDAN KUNKLE
Credential	:
Telephone Number	:	561-530-2149

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	09/12/2024

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