Provider Demographics
NPI:1588878672
Name:NEW EAR HEARING
Entity type:Organization
Organization Name:NEW EAR HEARING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SYSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-294-9887
Mailing Address - Street 1:31503 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2455
Mailing Address - Country:US
Mailing Address - Phone:586-294-9887
Mailing Address - Fax:586-469-1316
Practice Address - Street 1:31503 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2455
Practice Address - Country:US
Practice Address - Phone:586-294-9887
Practice Address - Fax:586-469-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS002594237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E007710OtherBCBS
MI=========OtherTAX ID