Provider Demographics
NPI:1013118751
Name:AUDIOLOGY CONSULTANTS OF CORTLAND, PC
Entity Type:Organization
Organization Name:AUDIOLOGY CONSULTANTS OF CORTLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:607-756-8915
Mailing Address - Street 1:9 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2709
Mailing Address - Country:US
Mailing Address - Phone:607-756-8915
Mailing Address - Fax:607-756-1820
Practice Address - Street 1:9 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2709
Practice Address - Country:US
Practice Address - Phone:607-756-8915
Practice Address - Fax:607-756-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001450-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0284Medicare ID - Type Unspecified