Provider Demographics
NPI:1487805230
Name:SUBURBAN AUDIOLOGY AND BALANCE CENTER, LLC
Entity type:Organization
Organization Name:SUBURBAN AUDIOLOGY AND BALANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MACIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:610-647-3710
Mailing Address - Street 1:11 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1632
Mailing Address - Country:US
Mailing Address - Phone:610-647-3710
Mailing Address - Fax:610-647-6851
Practice Address - Street 1:11 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1632
Practice Address - Country:US
Practice Address - Phone:610-647-3710
Practice Address - Fax:610-647-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001014L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126295Medicare PIN