Provider Demographics
NPI:1942314273
Name:TOBACK, FRIEDA (MA CCC A)
Entity Type:Individual
Prefix:
First Name:FRIEDA
Middle Name:
Last Name:TOBACK
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:
Other - First Name:FRIEDA
Other - Middle Name:
Other - Last Name:CELNIKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 FIESTA CT
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-289-3997
Mailing Address - Fax:
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:MCGUIRES HEARING AID SERVICE
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-758-3709
Practice Address - Fax:631-758-3731
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00000614231H00000X
NY1439000003966231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000614Medicaid
S18173Medicare UPIN
NY00000614Medicaid