Healthcare Provider Details

I. General information

NPI: 1215249040
Provider Name (Legal Business Name): QUEENS AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 3RD AVE
NEW YORK NY
10028-1802
US

IV. Provider business mailing address

15012 14TH AVE SUITE 200
WHITESTONE NY
11357-1800
US

V. Phone/Fax

Practice location:
  • Phone: 212-792-3900
  • Fax: 212-937-0052
Mailing address:
  • Phone: 718-279-4327
  • Fax: 718-279-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001479-2
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number15000018524
License Number StateNY

VIII. Authorized Official

Name: JOANNA ROUFOS
Title or Position: OWNER
Credential: AUD
Phone: 212-792-3900