MEDICARE: FORTELL RESEARCH 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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1578437075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTELL RESEARCH INC.

Provider Business Mailing Address
First Line	:	379 W BROADWAY OFC 549
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-5121
Country	:	US
Telephone Number	:	917-382-4354
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-8015
Country	:	US
Telephone Number	:	917-382-4354
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL AUDIOLOGIST
Name	:	KATHLEEN WALLACE
Credential	:	AUD
Telephone Number	:	917-382-4354

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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