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General NPI Number Information
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NPI Number | 1063580678
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Entity Type | Individual
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Provider Name | LYNN WALLACK SIROW PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 191 MAIN ST PORT WASHINGTON HEARING CENTER LLC
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3231
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Country | US
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Telephone | 516-883-9311
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Fax | 516-883-3652
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Provider Business Mailing Address
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Address Line | 191 MAIN ST PORT WASHINGTON HEARING CENTER LLC
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3231
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Country | US
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Telephone | 516-883-9311
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Fax | 516-883-3652
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 000551-1
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License Number State | NY
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