Provider Demographics
NPI:1760934954
Name:ADVANCED AUDIOLOGY OF NY II PC
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY OF NY II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JASEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1845-501-7339
Mailing Address - Street 1:102 E ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2910
Mailing Address - Country:US
Mailing Address - Phone:845-501-7339
Mailing Address - Fax:
Practice Address - Street 1:102 E ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2910
Practice Address - Country:US
Practice Address - Phone:845-501-7339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment