Provider Demographics
NPI:1184760191
Name:WALLIN, ANN (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WALLIN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LONGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6033
Mailing Address - Country:US
Mailing Address - Phone:732-271-0134
Mailing Address - Fax:
Practice Address - Street 1:447 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3205
Practice Address - Country:US
Practice Address - Phone:718-745-2826
Practice Address - Fax:718-745-0040
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00860231H00000X
NY14000004612237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM0830POtherHIP
NY37077OtherGHI HMO
NY3C1369OtherHEALTH NET
NY100051671601OtherUNITEDHEALTHCARE MEDICAID
NY2306807 003OtherCIGNA MEDICARE
NYBK0046601OtherAMERICHOICE
NY137077OtherWELLCARE
NY4899768OtherGHI
NY161820OtherELDERPLAN GROUP #
NY2306807 004OtherCIGNA
NY64000311OtherRAILROAD MEDICARE
NY00000516716OtherUNITED HEALTHCARE
NY5539430OtherAETNA
NY632040OtherONE HEALTH PLAN
NYKS209OtherOXFORD
NYM04201OtherBLUE CROSS BLUE SHIELD
NY730000860NY01OtherANTHEM
NYP-53902391OtherMULTI-PLAN
NYM0420-1Medicare ID - Type Unspecified