Provider Demographics
NPI:1386477842
Name:SOUTH JERSEY HEARING AND TINNITUS, LLC
Entity type:Organization
Organization Name:SOUTH JERSEY HEARING AND TINNITUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUD
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVERS-BESWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-357-3277
Mailing Address - Street 1:217 LAUREL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 LAUREL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3635
Practice Address - Country:US
Practice Address - Phone:802-357-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty