Provider Demographics
NPI:1013340017
Name:HEARING AND TINNITUS MANAGEMENT AUDIOLOGY PLLC
Entity type:Organization
Organization Name:HEARING AND TINNITUS MANAGEMENT AUDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:LUISE
Authorized Official - Last Name:MARESCA-ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:631-780-4327
Mailing Address - Street 1:207 HALLOCK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3033
Mailing Address - Country:US
Mailing Address - Phone:631-780-4327
Mailing Address - Fax:631-675-6867
Practice Address - Street 1:207 HALLOCK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3033
Practice Address - Country:US
Practice Address - Phone:631-780-4327
Practice Address - Fax:631-675-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001972-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty