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General NPI Number Information
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NPI Number | 1548570807
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Entity Type | Organization
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Legal Business Name | EASTSIDE AUDIOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 4000 MEDICAL CENTER DR SUITE 404
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-6631
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Country | US
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Telephone | 315-454-7315
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Fax | 315-617-3694
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Provider Business Mailing Address
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Address Line | 4000 MEDICAL CENTER DR SUITE 404
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-6631
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Country | US
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Telephone | 315-454-7315
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Fax | 315-617-3694
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | DR. SUZANNE M. KATKO
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Credential | AUD, CCC-A
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Telephone | 315-454-7315
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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
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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 | 001041
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License Number State | NY
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