Provider Demographics
NPI:1891841029
Name:NORTH SHORE HEARING CENTER,LLC
Entity type:Organization
Organization Name:NORTH SHORE HEARING CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:978-462-9628
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:SUITE #304
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2910
Mailing Address - Country:US
Mailing Address - Phone:978-531-0402
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE #304
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-531-0402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24W231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9727469Medicaid
MA36257OtherHARVARD PILGRIM
MA696651OtherTUFT'S
MAAG0021OtherBLUE CROSS BLUE SHEILD
MA9727469Medicaid