Provider Demographics
NPI:1790776185
Name:WALIGORA, JANE M (AUD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:M
Last Name:WALIGORA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-0507
Mailing Address - Country:US
Mailing Address - Phone:315-463-1724
Mailing Address - Fax:315-463-4020
Practice Address - Street 1:6700 KIRKVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-463-1724
Practice Address - Fax:315-463-4020
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000093-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD7011Medicare ID - Type UnspecifiedAUDIOLOGIST