Healthcare Provider Details

I. General information

NPI: 1588813505
Provider Name (Legal Business Name): NEW YORK AUDIOLOGICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E 28TH ST
BROOKLYN NY
11229-2514
US

IV. Provider business mailing address

1815 E 28TH ST
BROOKLYN NY
11229-2514
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-3105
  • Fax: 718-228-2538
Mailing address:
  • Phone: 718-336-3105
  • Fax: 718-228-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number1803
License Number StateNY

VIII. Authorized Official

Name: MRS. CHANA LEVY
Title or Position: PRESIDENT
Credential: MSCCCA
Phone: 718-336-3105