Provider Demographics
NPI:1972850931
Name:AUDIOLOGY DISTRIBUTION, LLC
Entity type:Organization
Organization Name:AUDIOLOGY DISTRIBUTION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-530-2149
Mailing Address - Street 1:PO BOX 200132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0021
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:
Practice Address - Street 1:1255 BROAD ST STE 206
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3061
Practice Address - Country:US
Practice Address - Phone:561-478-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty