Healthcare Provider Details

I. General information

NPI: 1457575482
Provider Name (Legal Business Name): SOLOMON SHOTLAND AUDIOLOGY & HEARING CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 MAMARONECK AVE BLDG 4
WHITE PLAINS NY
10605-2523
US

IV. Provider business mailing address

785 MAMARONECK AVE BLDG 4
WHITE PLAINS NY
10605-2523
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-0034
  • Fax: 914-949-0717
Mailing address:
  • Phone: 914-949-0034
  • Fax: 914-949-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000619-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number15000011852
License Number StateNY

VIII. Authorized Official

Name: MRS. MAGGIE MCKEON
Title or Position: OFFICE MANAGER
Credential:
Phone: 914-949-0034