=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700016565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW YORK AUDIOLOGY CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2009
-----------------------------------------------------
Last Update Date | 07/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NEW YORK AUDIOLOGY CENTER, INC. 444 E. 82ND STREET, APT. 28D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-5929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-628-4597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | NEW YORK AUDIOLOGY CENTER, INC. 444 E. 82ND STREET, APT. 28D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-5929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-628-4597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MA CCC SLP
-----------------------------------------------------
Name | MRS. SHIELA SUSAN FLAXMAN
-----------------------------------------------------
Credential | S.L.P.
-----------------------------------------------------
Telephone | 212-499-0691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 001073-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------