Healthcare Provider Details

I. General information

NPI: 1174599765
Provider Name (Legal Business Name): ISLAND HEARING & BALANCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 HEMPSTEAD TPKE SUITE 200
LEVITTOWN NY
11756
US

IV. Provider business mailing address

2870 HEMPSTEAD TPKE SUITE 200
LEVITTOWN NY
11756
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-6644
  • Fax: 516-731-8746
Mailing address:
  • Phone: 516-731-6644
  • Fax: 516-731-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M CAPO
Title or Position: OWNER / AUTHORIZED OFFICIAL
Credential: MD
Phone: 516-731-6644