Healthcare Provider Details

I. General information

NPI: 1164698106
Provider Name (Legal Business Name): HEAR HERE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 MAIN ST
UNADILLA NY
13849-0703
US

IV. Provider business mailing address

PO BOX C 194 MAIN ST.
UNADILLA NY
13849-0703
US

V. Phone/Fax

Practice location:
  • Phone: 607-369-3802
  • Fax: 607-369-5802
Mailing address:
  • Phone: 607-369-3802
  • Fax: 607-369-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001276-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number15000000167
License Number StateNY

VIII. Authorized Official

Name: MR. WAYNE STEPHEN TERRY
Title or Position: PARTNER
Credential: M.A., CCC-A
Phone: 607-369-3802