Healthcare Provider Details

I. General information

NPI: 1518873082
Provider Name (Legal Business Name): LAIBA ISHTIAQ CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 N LITTLE TOR RD
NEW CITY NY
10956-2627
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-999-3060
  • Fax: 845-999-3059
Mailing address:
  • Phone: 845-220-3100
  • Fax: 845-534-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA000143200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: