=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215242078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G.R. ZACCARIA & ASSOC. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2010
-----------------------------------------------------
Last Update Date | 08/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5100 W TAFT RD SUITE 1T
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13088-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-457-2004
-----------------------------------------------------
Fax | 315-452-2326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 W TAFT RD SUITE 1T
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13088-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-457-2004
-----------------------------------------------------
Fax | 315-452-2326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RICHARD ZACCARIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-457-2004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 15000019140
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------