Provider Demographics
NPI:1548570807
Name:EASTSIDE AUDIOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:EASTSIDE AUDIOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KATKO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:315-454-7315
Mailing Address - Street 1:4000 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6631
Mailing Address - Country:US
Mailing Address - Phone:315-454-7315
Mailing Address - Fax:315-617-3694
Practice Address - Street 1:4000 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 404
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6631
Practice Address - Country:US
Practice Address - Phone:315-454-7315
Practice Address - Fax:315-617-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001041231H00000X
NY000093231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty