Healthcare Provider Details

I. General information

NPI: 1801236476
Provider Name (Legal Business Name): STATE HEARING AND AUDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 STATE ROUTE 56
POTSDAM NY
13676-3547
US

IV. Provider business mailing address

6609 STATE ROUTE 56
POTSDAM NY
13676-3547
US

V. Phone/Fax

Practice location:
  • Phone: 315-508-4327
  • Fax: 315-262-0300
Mailing address:
  • Phone: 315-508-4327
  • Fax: 315-262-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number002042-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number002042-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number14000020423
License Number StateNY

VIII. Authorized Official

Name: MR. JON D SUAREZ
Title or Position: OWNER/AUDIOLOGIST
Credential: M.S., F/AAA
Phone: 315-508-4327