Provider Demographics
NPI:1861468050
Name:HART, STEPHEN THOMAS (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:HART
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3541
Mailing Address - Country:US
Mailing Address - Phone:585-266-4130
Mailing Address - Fax:585-266-4532
Practice Address - Street 1:468 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3541
Practice Address - Country:US
Practice Address - Phone:585-266-4130
Practice Address - Fax:585-266-4532
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000727237600000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02582305Medicaid
NY12181AMedicare PIN
NY12181BMedicare UPIN