Provider Demographics
NPI:1033112974
Name:SERVEDIO, DOMINICK (AUDIOLOGY PC)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:SERVEDIO
Suffix:
Gender:M
Credentials:AUDIOLOGY PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:SUITE 910
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:917-441-6094
Mailing Address - Fax:917-441-6102
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 910
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:917-441-6094
Practice Address - Fax:917-441-6102
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1080231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP-12043249OtherMULTIPLAN
NY200211575OtherMAGNACARE
NY241110OtherUNITED HEALTH CARE
NY3C4625OtherHEALTHNET
NY801141OtherHEALTH FIRST
NY200211575OtherPHCS
NYSD1080OtherATLANTIS
NY160570POtherHIP
NY174255OtherELDERPLAN
NYP3028736OtherOXFORD
NY801141OtherHEALTH FIRST