Healthcare Provider Details

I. General information

NPI: 1417023524
Provider Name (Legal Business Name): ARTHUR PODWALL PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CRAWFORD ST
SMITHTOWN NY
11787-1903
US

IV. Provider business mailing address

17 CRAWFORD ST
SMITHTOWN NY
11787-1903
US

V. Phone/Fax

Practice location:
  • Phone: 631-360-0033
  • Fax: 631-780-5985
Mailing address:
  • Phone: 631-360-0033
  • Fax: 631-780-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR PODWALL
Title or Position: AUDIOLOGIST & SPEECH PATHOLOGIST
Credential: PHD
Phone: 631-360-3222