Healthcare Provider Details

I. General information

NPI: 1992841118
Provider Name (Legal Business Name): SUSAN S DEBRUYNE D/B/A SOUTHSIDE HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E SOUTH ST STE 400A
GENESEO NY
14454-1300
US

IV. Provider business mailing address

50 E SOUTH ST STE 400A
GENESEO NY
14454-1300
US

V. Phone/Fax

Practice location:
  • Phone: 585-243-7690
  • Fax:
Mailing address:
  • Phone: 585-243-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number15000009122
License Number StateNY

VIII. Authorized Official

Name: DR. SUSAN S DEBRUYNE
Title or Position: OWNER
Credential: AU.D
Phone: 585-243-7690