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General NPI Number Information
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NPI Number | 1992841118
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Entity Type | Organization
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Legal Business Name | SUSAN S DEBRUYNE D/B/A SOUTHSIDE HEARING CENTER
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 50 E SOUTH ST STE 400A
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City | GENESEO
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State | NY
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Zip | 14454-1300
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Country | US
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Telephone | 585-243-7690
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Fax |
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Provider Business Mailing Address
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Address Line | 50 E SOUTH ST STE 400A
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City | GENESEO
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State | NY
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Zip | 14454-1300
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Country | US
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Telephone | 585-243-7690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN S DEBRUYNE
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Credential | AU.D
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Telephone | 585-243-7690
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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 | 15000009122
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License Number State | NY
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