Provider Demographics
NPI:1730307935
Name:EAST END HEARING AND SPEECH
Entity Type:Organization
Organization Name:EAST END HEARING AND SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-331-6455
Mailing Address - Street 1:4747-8 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2878
Mailing Address - Country:US
Mailing Address - Phone:631-331-6455
Mailing Address - Fax:
Practice Address - Street 1:4747-8 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2878
Practice Address - Country:US
Practice Address - Phone:631-331-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty