Healthcare Provider Details

I. General information

NPI: 1669518452
Provider Name (Legal Business Name): AUDIOLOGICAL DIAGNOSTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 77TH ST
BROOKLYN NY
11209-3205
US

IV. Provider business mailing address

447 77TH ST
BROOKLYN NY
11209-3205
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-2826
  • Fax: 718-745-0040
Mailing address:
  • Phone: 718-745-2826
  • Fax: 718-745-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number15000002425
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DASSAN ALI
Title or Position: PRESIDENT
Credential: SCD., CCC-A
Phone: 718-745-2826