Provider Demographics
NPI:1245397462
Name:DELAWARE AUDIOLOGY GROUP, P.C.
Entity Type:Organization
Organization Name:DELAWARE AUDIOLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:716-886-6462
Mailing Address - Street 1:1083 DELAWARE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1635
Mailing Address - Country:US
Mailing Address - Phone:716-886-6462
Mailing Address - Fax:716-886-6465
Practice Address - Street 1:1083 DELAWARE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1635
Practice Address - Country:US
Practice Address - Phone:716-886-6462
Practice Address - Fax:716-886-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00835231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty