MEDICARE: DR. SUZIE CATHERINE IP AUD

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	231H00000X	Audiologist	002302	NY
2	237600000X	Audiologist-Hearing Aid Fitter	002302	NY

General Provider Information

NPI Number	:	1558674051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZIE CATHERINE IP AUD

Provider Business Mailing Address
First Line	:	7554 197TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11366-1817
Country	:	US
Telephone Number	:	917-279-7036
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 1ST AVE FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4004
Country	:	US
Telephone Number	:	917-256-4247
Fax Number	:

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

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/13/2012

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