Healthcare Provider Details

I. General information

NPI: 1639105901
Provider Name (Legal Business Name): FAMILY AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOOPER RD SUITE 370
ENDWELL NY
13760-1560
US

IV. Provider business mailing address

800 HOOPER RD SUITE 370
ENDWELL NY
13760-1560
US

V. Phone/Fax

Practice location:
  • Phone: 607-786-5130
  • Fax: 607-786-4637
Mailing address:
  • Phone: 607-786-5130
  • Fax: 607-786-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001485
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number15000011888
License Number StateNY

VIII. Authorized Official

Name: KRISTI H LENIEK
Title or Position: AUDIOLOGIST/OWNER
Credential: MS, CCC-A
Phone: 607-786-5130