Provider Demographics
NPI:1154785293
Name:SALUS UNIVERSITY HEARING VISION BALANCE CLINIC
Entity type:Organization
Organization Name:SALUS UNIVERSITY HEARING VISION BALANCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF CLINICAL OPERATIO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-276-6000
Mailing Address - Street 1:8360 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8360 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1576
Practice Address - Country:US
Practice Address - Phone:215-276-6000
Practice Address - Fax:215-276-1329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALUS UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-05
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG0000989152W00000X
PAPT006133L225100000X
PAAT005895231H00000X
PAAT006180231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026958OtherMEDICARE GROUP NUMBER