Healthcare Provider Details

I. General information

NPI: 1578568846
Provider Name (Legal Business Name): CAROLYN M. GENNA AUD, FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HILLSIDE AVE STE 99H
WILLISTON PARK NY
11596-2333
US

IV. Provider business mailing address

99 HILLSIDE AVE STE 99H
WILLISTON PARK NY
11596-2333
US

V. Phone/Fax

Practice location:
  • Phone: 516-873-9742
  • Fax: 516-873-9861
Mailing address:
  • Phone: 516-873-9742
  • Fax: 516-873-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001105
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: