Provider Demographics
NPI:1700016565
Name:NEW YORK AUDIOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:NEW YORK AUDIOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA CCC SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIELA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:FLAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:212-499-0691
Mailing Address - Street 1:NEW YORK AUDIOLOGY CENTER, INC.
Mailing Address - Street 2:444 E. 82ND STREET, APT. 28D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5929
Mailing Address - Country:US
Mailing Address - Phone:212-628-4597
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK AUDIOLOGY CENTER, INC.
Practice Address - Street 2:444 E. 82ND STREET, APT. 28D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5929
Practice Address - Country:US
Practice Address - Phone:212-628-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001073-1320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3032714ACOtherHIP