Healthcare Provider Details

I. General information

NPI: 1275744286
Provider Name (Legal Business Name): JOANNE TZORTZATOS MS,CCC-A, AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-20 25TH AVENUE
JACKSON HEIGHTS NY
11370-1428
US

IV. Provider business mailing address

74-20 25TH AVENUE
JACKSON HEIGHTS NY
11370-1428
US

V. Phone/Fax

Practice location:
  • Phone: 718-350-3171
  • Fax: 718-458-1367
Mailing address:
  • Phone: 718-350-3171
  • Fax: 718-458-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0018561
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000014873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: