Provider Demographics
NPI:1821251448
Name:LOAVENBRUCK AUDIOLOGY, PC
Entity Type:Organization
Organization Name:LOAVENBRUCK AUDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOAVENBRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:845-362-1350
Mailing Address - Street 1:500 NEW HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1132
Mailing Address - Country:US
Mailing Address - Phone:845-362-1350
Mailing Address - Fax:845-362-3599
Practice Address - Street 1:500 NEW HEMPSTEAD RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1132
Practice Address - Country:US
Practice Address - Phone:845-362-1350
Practice Address - Fax:845-362-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM00181Medicare PIN