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General NPI Number Information
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NPI Number | 1922380971
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND AUDIOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 1173 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2408
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Country | US
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Telephone | 718-981-6020
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Fax | 718-876-8370
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Provider Business Mailing Address
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Address Line | 1173 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2408
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Country | US
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Telephone | 718-981-6020
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Fax | 718-876-8370
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY E GOODACRE
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Credential | AUD, CCC-A
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Telephone | 718-981-6020
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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 | 000603
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License Number State | NY
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