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General NPI Number Information
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NPI Number | 1417448366
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Entity Type | Organization
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Legal Business Name | D.C. AUDIOLOGY, P.C.
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Dates
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Enumeration Date | 05/27/2018
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 113 CROSSWAYS PARK DR STE 101
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City | WOODBURY
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State | NY
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Zip | 11797-2044
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Country | US
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Telephone | 516-644-7436
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Fax |
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Provider Business Mailing Address
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Address Line | 113 CROSSWAYS PARK DR STE 101
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City | WOODBURY
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State | NY
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Zip | 11797-2044
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Country | US
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Telephone | 516-364-0011
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANA CALLESANO
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Credential | AU.D.
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Telephone | 516-364-0011
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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 | 002531
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License Number State | NY
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