Provider Demographics
NPI:1275726911
Name:EASTERN AUDIOLOGY RESOURCES, LTD., PC
Entity Type:Organization
Organization Name:EASTERN AUDIOLOGY RESOURCES, LTD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BRESSI
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD,CCC
Authorized Official - Phone:516-674-9300
Mailing Address - Street 1:70 GLEN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2855
Mailing Address - Country:US
Mailing Address - Phone:516-674-9300
Mailing Address - Fax:516-674-9345
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2855
Practice Address - Country:US
Practice Address - Phone:516-674-9300
Practice Address - Fax:516-674-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01119199Medicaid
NYM01631Medicare PIN