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General NPI Number Information
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NPI Number | 1962747295
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Entity Type | Individual
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Provider Name | FRANK AVERSA
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Gender | Male
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1739 E MAIN ST
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547-1356
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Country | US
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Telephone | 914-397-1885
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Fax |
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Provider Business Mailing Address
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Address Line | 12 JUSTIN CT
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-5235
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 14000015490
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License Number State | NY
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