Provider Demographics
NPI:1568638161
Name:REBECCA KOOPER AUDIOLOGY, PC
Entity Type:Organization
Organization Name:REBECCA KOOPER AUDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:516-568-2000
Mailing Address - Street 1:241 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5827
Mailing Address - Country:US
Mailing Address - Phone:516-568-2000
Mailing Address - Fax:516-568-2002
Practice Address - Street 1:241 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5827
Practice Address - Country:US
Practice Address - Phone:516-568-2000
Practice Address - Fax:516-568-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000329-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty