MEDICARE: DR. JENNIFER LYNN DIMARCO AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter		NY
2	231H00000X	Audiologist	002347	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14000031354	OTHER	NY	HEARING AID DISPENSER TRAINEE

General Provider Information

NPI Number	:	1528351293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN DIMARCO AU.D.

Provider Business Mailing Address
First Line	:	771 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3346
Country	:	US
Telephone Number	:	631-673-5820
Fax Number	:	631-673-5825

Provider Business Practice Location Address
First Line	:	771 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3346
Country	:	US
Telephone Number	:	631-673-5820
Fax Number	:	631-673-5825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	10/18/2018

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