MEDICARE: KATHERINE MAFFETONE AUD

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	002735	NY

General Provider Information

NPI Number	:	1831617117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MAFFETONE AUD

Provider Business Mailing Address
First Line	:	113 CROSSWAYS PARK DR STE 101
Second Line	:
City	:	WOODBURY
State	:	NY
Zip	:	11797-2044
Country	:	US
Telephone Number	:	516-364-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 CROSSWAYS PARK DR STE 101
Second Line	:
City	:	WOODBURY
State	:	NY
Zip	:	11797-2044
Country	:	US
Telephone Number	:	516-364-0011
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	02/15/2018

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