MEDICARE: MR. JORGE SPENCER ZAVALA AU.D.

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	231H00000X	Audiologist	AT006195	PA
2	237600000X	Audiologist-Hearing Aid Fitter	AT006195	PA

General Provider Information

NPI Number	:	1962408609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE SPENCER ZAVALA AU.D.

Provider Business Mailing Address
First Line	:	917 JENIFER RD
Second Line	:
City	:	HORSHAM
State	:	PA
Zip	:	19044-1021
Country	:	US
Telephone Number	:	646-351-3686
Fax Number	:	610-277-8255

Provider Business Practice Location Address
First Line	:	710 E JOHNSON HWY
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-3110
Country	:	US
Telephone Number	:	610-277-3336
Fax Number	:	610-277-8255

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	06/17/2022

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