Provider Demographics
NPI:1205545282
Name:MLR AUDIOLOGY PC
Entity type:Organization
Organization Name:MLR AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-773-8730
Mailing Address - Street 1:1400 AVENUE Z STE 203
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3837
Mailing Address - Country:US
Mailing Address - Phone:718-745-6363
Mailing Address - Fax:718-836-2223
Practice Address - Street 1:1400 AVENUE Z STE 203
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3837
Practice Address - Country:US
Practice Address - Phone:718-745-6363
Practice Address - Fax:718-836-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty