Healthcare Provider Details

I. General information

NPI: 1073857660
Provider Name (Legal Business Name): LISA PREDMORE AUD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 NORTHERN BLVD STE 302
MANHASSET NY
11030-3048
US

IV. Provider business mailing address

1165 NORTHERN BLVD STE 302
MANHASSET NY
11030-3048
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-7600
  • Fax: 516-627-6378
Mailing address:
  • Phone: 516-627-7600
  • Fax: 516-627-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: LISA PREDMORE
Title or Position: OWNER
Credential:
Phone: 516-627-7600