Healthcare Provider Details

I. General information

NPI: 1366590010
Provider Name (Legal Business Name): STUART MOTECHIN M.S. CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 ATLANTIC AVE
BROOKLYN NY
11201-5502
US

IV. Provider business mailing address

330 CHURCH AVE
WOODMERE NY
11598-2816
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1498
  • Fax: 718-780-2819
Mailing address:
  • Phone: 516-241-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1578-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: