Provider Demographics
NPI:1760751507
Name:BROOKLYN AUDIOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BROOKLYN AUDIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KANER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, F-AAA
Authorized Official - Phone:718-745-6363
Mailing Address - Street 1:8502 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4608
Mailing Address - Country:US
Mailing Address - Phone:718-745-6363
Mailing Address - Fax:718-836-2223
Practice Address - Street 1:8502 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4608
Practice Address - Country:US
Practice Address - Phone:718-745-6363
Practice Address - Fax:718-836-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000556-1332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100064696Medicare PIN