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General NPI Number Information
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NPI Number | 1679852016
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Entity Type | Organization
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Legal Business Name | CORTLAND AUDIOLOGY, PC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 1033 STATE ROUTE 13
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City | CORTLAND
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State | NY
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Zip | 13045
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Country | US
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Telephone | 607-756-1053
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Fax | 607-299-4547
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Provider Business Mailing Address
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Address Line | 1033 STATE ROUTE 13
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City | CORTLAND
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State | NY
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Zip | 13045-3453
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Country | US
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Telephone | 607-756-1053
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Fax | 607-299-4547
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Authorized Official
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Title or Position | AUD
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Name | SUZETTE PACE
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Credential |
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Telephone | 607-756-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 0016891
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License Number State | NY
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