Provider Demographics
NPI:1073778700
Name:ROUFOS, JOANNA (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:ROUFOS
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15012 14TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1800
Mailing Address - Country:US
Mailing Address - Phone:718-279-4327
Mailing Address - Fax:718-279-1281
Practice Address - Street 1:15012 14TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1800
Practice Address - Country:US
Practice Address - Phone:718-279-4327
Practice Address - Fax:718-279-1281
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001479-1231H00000X
NY14000022298237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03164174Medicaid
NY03164174Medicaid
NYA400021614Medicare PIN
NYA100021596Medicare PIN
NYG400008250Medicare PIN
NYA900054716Medicare PIN
NYA400054713Medicare PIN