Provider Demographics
NPI:1003956053
Name:SUSAN BOGGIA AUDIOLOGY, PC
Entity Type:Organization
Organization Name:SUSAN BOGGIA AUDIOLOGY, PC
Other - Org Name:LKE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:518-798-4800
Mailing Address - Street 1:318 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-1506
Mailing Address - Country:US
Mailing Address - Phone:518-798-4800
Mailing Address - Fax:
Practice Address - Street 1:318 RIDGE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-1506
Practice Address - Country:US
Practice Address - Phone:518-798-4800
Practice Address - Fax:518-798-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2751396OtherUNITED HEALTH CARE
00413681001OtherHEALTH NOW
080318000032OtherFIDELIS
1613948OtherGHI
M77121OtherEMPIRE BLUECROSS BLUESHIELD
00413681001OtherHEALTH NOW