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NPI Code Detail

MEDICARE: RILEY M TERRY AUD

MEDICARE: RILEY M TERRY AUD
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
1231H00000XAudiologist5503NM
2231H00000XAudiologistA-2488NV

General Provider Information

NPI Number : 1629488846
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY M TERRY AUD
Provider Business Mailing Address
First Line : 2501 COTTONTAIL LN
Second Line :
City : SOMERSET
State : NJ
Zip : 08873-5125
Country : US
Telephone Number : 732-529-7120
Fax Number : 207-226-2064
Provider Business Practice Location Address
First Line : 3120 S RAINBOW BLVD STE 202
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-6235
Country : US
Telephone Number : 702-233-4327
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2014
Last Update Date : 03/25/2019

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Directions to “ RILEY M TERRY AUD” Practice Location

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