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General NPI Number Information
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NPI Number | 1871525196
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Entity Type | Individual
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Provider Name | RENE LEE DOUGLAS AU.D., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | ROUTE 9D DEPARTMENT OF VETERANS AFFAIRS CASTLE POINT CAMPUS
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City | CASTLE POINT
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State | NY
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Zip | 12511
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Country | US
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Telephone | 845-838-5226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | MONTROSE
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State | NY
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Zip | 10548-0100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 001574-1
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License Number State | NY
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