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General NPI Number Information
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NPI Number | 1366621617
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Entity Type | Organization
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Legal Business Name | J WALIGORA AUDIOLOGY PC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 6700 KIRKVILLE RD SUITE 107
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9305
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Country | US
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Telephone | 315-463-1724
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Fax | 315-463-4020
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Provider Business Mailing Address
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Address Line | 6700 KIRKVILLE RD SUITE 107
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9305
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Country | US
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Telephone | 315-463-1724
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Fax | 315-463-4020
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. ROGER WALIGORA
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Credential |
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Telephone | 315-463-1724
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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 | 000093-1
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License Number State | NY
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