Provider Demographics
NPI:1326114430
Name:SYOSSET SPEECH & HEARING
Entity Type:Organization
Organization Name:SYOSSET SPEECH & HEARING
Other - Org Name:ARTHUR PODWALL, PH.D. & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AUD & SPEECH PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PODWALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-364-1234
Mailing Address - Street 1:175 JERICHO TPKE STE 103
Mailing Address - Street 2:SYOSSET SPEECH & HEARING
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4546
Mailing Address - Country:US
Mailing Address - Phone:516-364-1234
Mailing Address - Fax:516-364-3132
Practice Address - Street 1:175 JERICHO TPKE STE 103
Practice Address - Street 2:SYOSSET SPEECH & HEARING
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4501
Practice Address - Country:US
Practice Address - Phone:516-364-1234
Practice Address - Fax:516-364-3132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARTHUR PODWALL DBA SYOSSET SPEECH & HEARING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM0W001Medicare PIN