1386040053 NPI number — JAMES PRONESTI AUDIOLOGY CONSULTANT PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386040053 NPI number — JAMES PRONESTI AUDIOLOGY CONSULTANT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES PRONESTI AUDIOLOGY CONSULTANT 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:
1386040053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9402 CHURCH AVE
Provider Second Line Business Mailing Address:
BOX 121058
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11212-1679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-525-4076
Provider Business Mailing Address Fax Number:
203-487-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9402 CHURCH AVE
Provider Second Line Business Practice Location Address:
BOX 121058
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-997-6490
Provider Business Practice Location Address Fax Number:
203-487-4490
Provider Enumeration Date:
11/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PRONESTI
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
AUDIOLOGIST
Authorized Official Telephone Number:
203-997-6490

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  000466 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X , with the licence number: 14000030167 , 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)

  • Identifier: 000466 . This is a "CT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 002171 . This is a "NYS LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170597 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03821987 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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