Provider Demographics
NPI:1134300957
Name:WARD, ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 LARKFIELD RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3136
Mailing Address - Country:US
Mailing Address - Phone:631-543-4327
Mailing Address - Fax:631-543-3735
Practice Address - Street 1:777 LARKFIELD RD
Practice Address - Street 2:SUITE 108
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3136
Practice Address - Country:US
Practice Address - Phone:631-543-4327
Practice Address - Fax:631-543-3735
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002142-1231H00000X
NY14000024350237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMA003M8322Medicare UPIN