Provider Demographics
NPI:1417122888
Name:DOMINICK SERVEDIO, AU.D, P.C.
Entity Type:Organization
Organization Name:DOMINICK SERVEDIO, AU.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SERVEDIO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:917-441-6094
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:SUITE 910
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:917-441-6094
Mailing Address - Fax:917-441-6102
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 910
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:917-441-6094
Practice Address - Fax:917-441-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1080231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM75911OtherEMPIRE BLUE CROSS BLUE SHEILD
NY241110OtherUNITED HEALTH CARE
NYP12043249OtherMULTIPLAN
NY174255OtherELDERPLAN
NY5C6011OtherHEALTHNET
NY7103327OtherCIGNA
NYSD1080OtherATLANTIS
NYP3028736OtherOXFORD
NY160570POtherHIP
NY1000048259OtherAFFINITY
NY4899667OtherGHI
NYWXQQX1Medicare PIN