Provider Demographics
NPI:1508458753
Name:WISE AUDIOLOGY PC
Entity Type:Organization
Organization Name:WISE AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOFYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:718-554-0017
Mailing Address - Street 1:9811 QUEENS BLVD STE 1D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3309
Mailing Address - Country:US
Mailing Address - Phone:718-554-0017
Mailing Address - Fax:718-440-3575
Practice Address - Street 1:9811 QUEENS BLVD STE 1D
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3309
Practice Address - Country:US
Practice Address - Phone:718-554-0017
Practice Address - Fax:718-440-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03727144Medicaid