Healthcare Provider Details

I. General information

NPI: 1063420487
Provider Name (Legal Business Name): MARY MARGARET GRIFFIN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 GRAND AVE
MASSAPEQUA NY
11758-4905
US

IV. Provider business mailing address

83 GRAND AVE
MASSAPEQUA NY
11758-4905
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-1502
  • Fax: 516-798-0150
Mailing address:
  • Phone: 516-798-1502
  • Fax: 516-798-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001685
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0016851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: