Healthcare Provider Details

I. General information

NPI: 1053584029
Provider Name (Legal Business Name): ALL EARS AUDIOLOGY OF ITHACA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PLEASANT GROVE RD
ITHACA NY
14850-2664
US

IV. Provider business mailing address

200 PLEASANT GROVE RD
ITHACA NY
14850-2664
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-3903
  • Fax: 607-266-8821
Mailing address:
  • Phone: 607-257-3903
  • Fax: 607-266-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000450
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number15000000623
License Number StateNY

VIII. Authorized Official

Name: MS. CAROL BASS
Title or Position: AUDIOLOGIST
Credential: M.S.
Phone: 607-257-3903