Healthcare Provider Details

I. General information

NPI: 1275989121
Provider Name (Legal Business Name): MILL NECK SERVICES CENTER FOR HEARING HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FROST MILL RD
MILL NECK NY
11765-1102
US

IV. Provider business mailing address

40 FROST MILL RD
MILL NECK NY
11765-1102
US

V. Phone/Fax

Practice location:
  • Phone: 516-628-4268
  • Fax: 516-922-3889
Mailing address:
  • Phone: 516-628-4268
  • Fax: 516-922-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name: LORRETTA H MURRAY
Title or Position: AUTHORIZED REP
Credential:
Phone: 516-628-4268