1508144643 NPI number — LYNN AUDIOLOGY AND HEARING AID SERVICES PC

Table of content: (NPI 1508144643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508144643 NPI number — LYNN AUDIOLOGY AND HEARING AID SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNN AUDIOLOGY AND HEARING AID SERVICES PC
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:
LYNN AND COHEN AUDIOLOGY PC
Provider Other Organization Name Type Code:
4
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:
1508144643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MATTHEWS ST.
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-1988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-294-8544
Provider Business Mailing Address Fax Number:
845-294-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MATTHEWS ST.
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10924-1988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-294-8544
Provider Business Practice Location Address Fax Number:
845-294-3117
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LYNN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/AUDIOLOGIST
Authorized Official Telephone Number:
845-294-8544

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  000480 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: 000314 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: M01053 . This is a "MEDICARE, NY, MANUEL COHEN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: M03182 . This is a "MEDICARE, NY, DEBORAH LYNN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1447309034 . This is a "NPI, DEBORAH LYNN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1699826727 . This is a "NPI, MANUEL COHEN" identifier . This identifiers is of the category "OTHER".




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