1245630839 NPI number — MID ISLAND AUDIOLOGY PLLC

Table of content: (NPI 1245630839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245630839 NPI number — MID ISLAND AUDIOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID ISLAND AUDIOLOGY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245630839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
STE 214
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590-5640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-334-7000
Provider Business Mailing Address Fax Number:
914-668-4932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11590-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-334-7000
Provider Business Practice Location Address Fax Number:
914-668-4932
Provider Enumeration Date:
09/02/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RECHER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER AUD
Authorized Official Telephone Number:
516-334-7000

Provider Taxonomy Codes

  • Taxonomy code: 231HA2500X , with the licence number:  002543-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)