MEDICARE: STATEN ISLAND AUDIOLOGY AND HEARING PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	001287-1	NY

General Provider Information

NPI Number	:	1336448380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATEN ISLAND AUDIOLOGY AND HEARING PC

Provider Business Mailing Address
First Line	:	78 TODT HILL RD
Second Line	:	SUITE 202
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4513
Country	:	US
Telephone Number	:	718-816-1952
Fax Number	:	718-816-5118

Provider Business Practice Location Address
First Line	:	78 TODT HILL RD
Second Line	:	SUITE 202
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4513
Country	:	US
Telephone Number	:	718-816-1952
Fax Number	:	718-816-5118

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERESA L CANNON
Credential	:	AU.D.
Telephone Number	:	718-816-1952

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	10/12/2015

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