MEDICARE: ONEIDA AUDIOLOGY, HEARING AND BALANCE, LLC

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	001041	NY

General Provider Information

NPI Number	:	1528294113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONEIDA AUDIOLOGY, HEARING AND BALANCE, LLC

Provider Business Mailing Address
First Line	:	221 BROAD ST
Second Line	:	SUITE 201
City	:	ONEIDA
State	:	NY
Zip	:	13421-2178
Country	:	US
Telephone Number	:	315-363-3310
Fax Number	:	315-363-5472

Provider Business Practice Location Address
First Line	:	221 BROAD ST
Second Line	:	SUITE 201
City	:	ONEIDA
State	:	NY
Zip	:	13421-2178
Country	:	US
Telephone Number	:	315-363-3310
Fax Number	:	315-363-5472

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUZANNE M KATKO
Credential	:	AUD, CCC-A
Telephone Number	:	315-363-3310

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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