Provider Demographics
NPI:1386823433
Name:MELANIE HERZFELD, AU.D. AUDIOLOGIST PC
Entity Type:Organization
Organization Name:MELANIE HERZFELD, AU.D. AUDIOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERZFELD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:516-364-0011
Mailing Address - Street 1:113 CROSSWAYS PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2044
Mailing Address - Country:US
Mailing Address - Phone:516-364-0011
Mailing Address - Fax:516-364-0013
Practice Address - Street 1:113 CROSSWAYS PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2044
Practice Address - Country:US
Practice Address - Phone:516-364-0011
Practice Address - Fax:516-364-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000134231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM9W201Medicare PIN