Healthcare Provider Details

I. General information

NPI: 1942314273
Provider Name (Legal Business Name): FRIEDA TOBACK MA CCC A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRIEDA CELNIKER

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST MCGUIRES HEARING AID SERVICE
PATCHOGUE NY
11772
US

IV. Provider business mailing address

6 FIESTA CT
PATCHOGUE NY
11772
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-3709
  • Fax: 631-758-3731
Mailing address:
  • Phone: 631-289-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00000614
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number1439000003966
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1439000003966
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00000614
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: