1639105901 NPI number — FAMILY AUDIOLOGY, PLLC

Table of content: (NPI 1639105901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639105901 NPI number — FAMILY AUDIOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY 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:
1639105901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 HOOPER RD
Provider Second Line Business Mailing Address:
SUITE 370
Provider Business Mailing Address City Name:
ENDWELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13760-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-786-5130
Provider Business Mailing Address Fax Number:
607-786-4637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOOPER RD
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
ENDWELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13760-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-786-5130
Provider Business Practice Location Address Fax Number:
607-786-4637
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LENIEK
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
AUDIOLOGIST/OWNER
Authorized Official Telephone Number:
607-786-5130

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  001485 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: 15000011888 , 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: BA0975 . This is a "PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com