Healthcare Provider Details

I. General information

NPI: 1700122017
Provider Name (Legal Business Name): JOHN WEIGAND AUDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LENOX RD SUITE J BOX 1283
BROOKLYN NY
11203-2017
US

IV. Provider business mailing address

445 LENOX RD SUITE J BOX 1283
BROOKLYN NY
11203-2017
US

V. Phone/Fax

Practice location:
  • Phone: 347-983-8918
  • Fax: 914-668-4932
Mailing address:
  • Phone: 347-983-8918
  • Fax: 914-668-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number0016191
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN WEIGAND
Title or Position: OWNWER/AUD
Credential:
Phone: 347-983-8918