Healthcare Provider Details

I. General information

NPI: 1841596624
Provider Name (Legal Business Name): MODERN AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W MILL DR APT 1H
GREAT NECK NY
11021-4054
US

IV. Provider business mailing address

4 W MILL DR APT 1H
GREAT NECK NY
11021-4054
US

V. Phone/Fax

Practice location:
  • Phone: 516-305-4404
  • Fax:
Mailing address:
  • Phone: 516-305-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number11881
License Number StateNY

VIII. Authorized Official

Name: DR. SHARON LYNN JUDLOWITZ
Title or Position: OWNER
Credential: AU.D.
Phone: 516-305-4404