Provider Demographics
NPI:1104395672
Name:CRESSWELL AUDIOLOGY PC
Entity Type:Organization
Organization Name:CRESSWELL AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:AUDD
Authorized Official - Phone:845-226-2638
Mailing Address - Street 1:2623 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3215
Mailing Address - Country:US
Mailing Address - Phone:845-226-2638
Mailing Address - Fax:845-226-2674
Practice Address - Street 1:2623 ROUTE 52
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-3215
Practice Address - Country:US
Practice Address - Phone:845-226-2638
Practice Address - Fax:845-226-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty