Provider Demographics
NPI:1861669160
Name:WESTSIDE AUDIOLOGY SERVICES,LLC
Entity Type:Organization
Organization Name:WESTSIDE AUDIOLOGY SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KATKO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:315-234-3842
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:STE 229
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-234-3842
Mailing Address - Fax:315-234-9858
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:STE 229
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-234-3842
Practice Address - Fax:315-234-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000006750332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1801867791Medicare UPIN