Healthcare Provider Details

I. General information

NPI: 1710051685
Provider Name (Legal Business Name): CRM AUDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 WESTCHESTER AVE STE 202
PURCHASE NY
10577-2500
US

IV. Provider business mailing address

2975 WESTCHESTER AVE STE 202
PURCHASE NY
10577-2500
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-1743
  • Fax: 914-437-7306
Mailing address:
  • Phone: 914-997-1743
  • Fax: 914-437-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1815
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number14000015622
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE RUSSO-MAYER
Title or Position: OWNER
Credential: AU.D.
Phone: 914-997-1743