Healthcare Provider Details

I. General information

NPI: 1093071573
Provider Name (Legal Business Name): CYNTHIA DIANE VULCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 LAKEVILLE RD
NEW HYDE PARK NY
11042-1121
US

IV. Provider business mailing address

430 LAKEVILLE ROAD
NEW HYDE PARK NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8910
  • Fax: 718-347-8241
Mailing address:
  • Phone: 718-470-8910
  • Fax: 718-347-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: