Provider Demographics
NPI:1386040053
Name:JAMES PRONESTI AUDIOLOGY CONSULTANT PLLC
Entity Type:Organization
Organization Name:JAMES PRONESTI AUDIOLOGY CONSULTANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PRONESTI
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:203-997-6490
Mailing Address - Street 1:9402 CHURCH AVE
Mailing Address - Street 2:BOX 121058
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1679
Mailing Address - Country:US
Mailing Address - Phone:347-525-4076
Mailing Address - Fax:203-487-4490
Practice Address - Street 1:9402 CHURCH AVE
Practice Address - Street 2:BOX 121058
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1679
Practice Address - Country:US
Practice Address - Phone:203-997-6490
Practice Address - Fax:203-487-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000466273Y00000X
NY14000030167332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000466OtherCT LICENSE
NY002171OtherNYS LICENSE
CT170597Medicaid
NY03821987Medicaid