Provider Demographics
NPI:1992841118
Name:SUSAN S DEBRUYNE D/B/A SOUTHSIDE HEARING CENTER
Entity Type:Organization
Organization Name:SUSAN S DEBRUYNE D/B/A SOUTHSIDE HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEBRUYNE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:585-243-7690
Mailing Address - Street 1:50 E SOUTH ST
Mailing Address - Street 2:STE 400A
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1300
Mailing Address - Country:US
Mailing Address - Phone:585-243-7690
Mailing Address - Fax:
Practice Address - Street 1:50 E SOUTH ST
Practice Address - Street 2:STE 400A
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1300
Practice Address - Country:US
Practice Address - Phone:585-243-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000009122332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment