MEDICARE: LEXINGTON HEARING AND SPEECH CENTER, INC.

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	261QH0700X	Hearing and Speech Clinic/Center	7003226R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487701876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON HEARING AND SPEECH CENTER, INC.

Provider Business Mailing Address
First Line	:	74-20 25TH AVE.
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11370-1428
Country	:	US
Telephone Number	:	718-350-3171
Fax Number	:	718-458-1367

Provider Business Practice Location Address
First Line	:	74-20 25TH AVE.
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11370-1428
Country	:	US
Telephone Number	:	718-350-3171
Fax Number	:	718-458-1367

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ADELE AGIN
Credential	:	LCSW
Telephone Number	:	718-350-3110

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	05/27/2010

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