MEDICARE: FRANK AVERSA

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	237700000X	Hearing Instrument Specialist	14000015490	NY

General Provider Information

NPI Number	:	1962747295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK AVERSA

Provider Business Mailing Address
First Line	:	12 JUSTIN CT
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-5235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1356
Country	:	US
Telephone Number	:	914-397-1885
Fax Number	:

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

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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Directions to “ FRANK AVERSA ” Practice Location

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