Healthcare Provider Details

I. General information

NPI: 1386003861
Provider Name (Legal Business Name): LONG ISLAND JEWISH MEDICAL CENTER - HEARING AND SPEECH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
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

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT S SHAPIRO
Title or Position: EXECUTIVE VP & CFO
Credential:
Phone: 516-465-8162