Provider Demographics
NPI:1073003158
Name:OLGA LIS AUDIOLOGY PC
Entity Type:Organization
Organization Name:OLGA LIS AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:719-333-1394
Mailing Address - Street 1:209 AVENUE P STE 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4982
Mailing Address - Country:US
Mailing Address - Phone:718-421-2782
Mailing Address - Fax:718-421-2783
Practice Address - Street 1:209 AVENUE P STE 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4982
Practice Address - Country:US
Practice Address - Phone:718-421-2782
Practice Address - Fax:718-421-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty