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General NPI Number Information
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NPI Number | 1255585766
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Entity Type | Organization
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Legal Business Name | TINNITUS AND HYPERACUSIS CENTER LLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 200 PLEASANT GROVE RD COMMUNITY CORNERS PLAZA
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City | ITHACA
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State | NY
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Zip | 14850-2664
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Country | US
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Telephone | 607-257-3903
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Fax | 607-266-8821
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Provider Business Mailing Address
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Address Line | 200 PLEASANT GROVE RD COMMUNITY CORNERS PLAZA
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City | ITHACA
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State | NY
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Zip | 14850-2664
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Country | US
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Telephone | 607-257-3903
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Fax | 607-266-8821
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | CAROL BASS
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Credential | MS
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Telephone | 607-257-3903
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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 | 15000000623
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License Number State | NY
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