Provider Demographics
NPI:1295933547
Name:HEARING CENTER OF ENFIELD, LLC
Entity type:Organization
Organization Name:HEARING CENTER OF ENFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A
Authorized Official - Phone:860-763-3271
Mailing Address - Street 1:145 HAZARD AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4521
Mailing Address - Country:US
Mailing Address - Phone:860-763-3271
Mailing Address - Fax:860-749-6265
Practice Address - Street 1:145 HAZARD AVE
Practice Address - Street 2:UNIT C
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4521
Practice Address - Country:US
Practice Address - Phone:860-763-3271
Practice Address - Fax:860-749-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000348332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGOtherAETNA, CONNECTICARE
CTPENDINGMedicaid
CTPENDINGOtherAETNA, CONNECTICARE