Provider Demographics
NPI:1821062233
Name:FINGER LAKES HEARING CENTER INC
Entity Type:Organization
Organization Name:FINGER LAKES HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-789-3595
Mailing Address - Street 1:64 ELIZABETH BLACKWELL STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-789-3595
Mailing Address - Fax:315-789-9051
Practice Address - Street 1:64 ELIZABETH BLACKWELL STREET SUITE C
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-789-3595
Practice Address - Fax:315-789-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10639AMedicare ID - Type UnspecifiedGROUP NUMBER