Provider Demographics
NPI:1053646554
Name:EDWARD D. MYSAK SPEECH AND HEARING CENTER
Entity Type:Organization
Organization Name:EDWARD D. MYSAK SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:212-678-3410
Mailing Address - Street 1:525 W 120TH ST
Mailing Address - Street 2:BOX 191
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6605
Mailing Address - Country:US
Mailing Address - Phone:212-678-3409
Mailing Address - Fax:212-678-3718
Practice Address - Street 1:525 W 120TH ST
Practice Address - Street 2:BOX 191
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6605
Practice Address - Country:US
Practice Address - Phone:212-678-3409
Practice Address - Fax:212-678-3718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEACHERS COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000535-1261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech