Provider Demographics
NPI:1871591305
Name:MAIN LINE AUDIOLOGY CONSULTANTS PC
Entity type:Organization
Organization Name:MAIN LINE AUDIOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDAU GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:610-667-3277
Mailing Address - Street 1:916 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-667-3277
Mailing Address - Fax:610-667-1662
Practice Address - Street 1:822 MONTGOMERY AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1937
Practice Address - Country:US
Practice Address - Phone:610-667-3277
Practice Address - Fax:610-667-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1322305OtherBS
PA2015581000OtherKEYSTONE
NJ052360Medicaid
PA079006Medicare ID - Type Unspecified