Healthcare Provider Details

I. General information

NPI: 1558623272
Provider Name (Legal Business Name): AUDIOLOGY ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 NEW DORP LN FL 2
STATEN ISLAND NY
10306-3004
US

IV. Provider business mailing address

148 NEW DORP LN FL 2
STATEN ISLAND NY
10306-3004
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-0188
  • Fax: 888-257-9323
Mailing address:
  • Phone: 718-980-0188
  • Fax: 888-257-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number002086
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number002086
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002086
License Number StateNY

VIII. Authorized Official

Name: DR. ZHANNETA SHAPIRO
Title or Position: AUDIOLOGIST
Credential: AUD
Phone: 718-980-0188