Provider Demographics
NPI:1417448366
Name:D.C. AUDIOLOGY, P.C.
Entity Type:Organization
Organization Name:D.C. AUDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLESANO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:516-364-0011
Mailing Address - Street 1:113 CROSSWAYS PARK DR STE 101
Mailing Address - Street 2:
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:
Practice Address - Street 1:113 CROSSWAYS PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2044
Practice Address - Country:US
Practice Address - Phone:516-644-7436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-27
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty