Provider Demographics
NPI:1053704387
Name:MD HEARING SOLUTIONS
Entity type:Organization
Organization Name:MD HEARING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W. BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:315-331-1313
Mailing Address - Street 1:1206 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-331-1313
Mailing Address - Fax:315-331-5828
Practice Address - Street 1:1206 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-331-1313
Practice Address - Fax:315-331-5828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W. BRADLEY SIMMONS MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000023805332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10632AMedicare PIN