MEDICARE: MRS. ROBBIE ANN BRIGHT-POOLE MS CCCA

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	41YA00024900	NJ

General Provider Information

NPI Number	:	1972588986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBBIE ANN BRIGHT-POOLE MS CCCA

Provider Business Mailing Address
First Line	:	74 BRICK BLVD
Second Line	:	BUILDING 4 SUITE 114
City	:	BRICK
State	:	NJ
Zip	:	08723-7984
Country	:	US
Telephone Number	:	732-920-7171
Fax Number	:	732-920-7722

Provider Business Practice Location Address
First Line	:	74 BRICK BLVD
Second Line	:	BUILDING 4 SUITE 114
City	:	BRICK
State	:	NJ
Zip	:	08723-7984
Country	:	US
Telephone Number	:	732-920-7171
Fax Number	:	732-920-7722

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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