MEDICARE: DR. SUSAN RUTH HOLLAR AU.D

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	000949	NY
2	237600000X	Audiologist-Hearing Aid Fitter	140000021026	NY

General Provider Information

NPI Number	:	1598768582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN RUTH HOLLAR AU.D

Provider Business Mailing Address
First Line	:	105 MARYS AVE
Second Line	:	DEPT OF AUDIOLOGY
City	:	KINGSTON
State	:	NY
Zip	:	12401-5848
Country	:	US
Telephone Number	:	845-334-3121
Fax Number	:	845-334-4789

Provider Business Practice Location Address
First Line	:	105 MARYS AVE
Second Line	:	DEPARTMENT OF AUDIOLOGY
City	:	KINGSTON
State	:	NY
Zip	:	12401-5848
Country	:	US
Telephone Number	:	845-334-3121
Fax Number	:	845-334-4789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/05/2009

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