Provider Demographics
NPI:1376048652
Name:EAST COAST AUDIOLOGY AND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:EAST COAST AUDIOLOGY AND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:315-786-3225
Mailing Address - Street 1:53-59 PUBLIC SQ STE 202
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-786-3225
Mailing Address - Fax:315-786-3215
Practice Address - Street 1:53-59 PUBLIC SQ STE 202
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2674
Practice Address - Country:US
Practice Address - Phone:315-786-3225
Practice Address - Fax:315-786-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021628-1225100000X
NY001576231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty