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General NPI Number Information
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NPI Number | 1164613055
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Entity Type | Individual
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Provider Name | LINDA DALLAS M.ED
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 01/17/2011
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Provider Practice Location Address
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Address Line | 259 1ST ST
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City | MINEOLA
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State | NY
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Zip | 11501-3957
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Country | US
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Telephone | 856-702-6100
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Fax | 856-396-0406
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Provider Business Mailing Address
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Address Line | 108 CENTRE BLVD SUITE I
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City | MARLTON
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State | NJ
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Zip | 08053-4132
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Country | US
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Telephone | 856-702-6100
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Fax | 856-396-0406
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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 | 002128-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT000679L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 000459
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License Number State | CT
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