Healthcare Provider Details

I. General information

NPI: 1538599048
Provider Name (Legal Business Name): MANHASSET AUDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HUGHES PL
ALBERTSON NY
11507-1601
US

IV. Provider business mailing address

143 HUGHES PL
ALBERTSON NY
11507-1601
US

V. Phone/Fax

Practice location:
  • Phone: 917-592-7158
  • Fax:
Mailing address:
  • Phone: 917-592-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002474
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000038440
License Number StateNY

VIII. Authorized Official

Name: ANNA PALTERMAN
Title or Position: OWNER
Credential: AUD
Phone: 917-592-7158