MEDICARE: BROOKLYN AUDIOLOGY ASSOCIATES, PC

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	332S00000X	Hearing Aid Equipment	000556-1	NY

General Provider Information

NPI Number	:	1760751507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN AUDIOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	8502 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4608
Country	:	US
Telephone Number	:	718-745-6363
Fax Number	:	718-836-2223

Provider Business Practice Location Address
First Line	:	8502 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4608
Country	:	US
Telephone Number	:	718-745-6363
Fax Number	:	718-836-2223

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD P. KANER
Credential	:	M.A., F-AAA
Telephone Number	:	718-745-6363

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	11/26/2012

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