Provider Demographics
NPI:1639105901
Name:FAMILY AUDIOLOGY, PLLC
Entity Type:Organization
Organization Name:FAMILY AUDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:H
Authorized Official - Last Name:LENIEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:607-786-5130
Mailing Address - Street 1:800 HOOPER RD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1560
Mailing Address - Country:US
Mailing Address - Phone:607-786-5130
Mailing Address - Fax:607-786-4637
Practice Address - Street 1:800 HOOPER RD
Practice Address - Street 2:SUITE 370
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1560
Practice Address - Country:US
Practice Address - Phone:607-786-5130
Practice Address - Fax:607-786-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001485231H00000X
NY15000011888237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0975OtherPTAN