Provider Demographics
NPI:1295991610
Name:PIEDE, ROBERT M (MA, CCC-A)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:PIEDE
Suffix:
Gender:M
Credentials:MA, 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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14702-0840
Mailing Address - Country:US
Mailing Address - Phone:716-664-8194
Mailing Address - Fax:716-664-8418
Practice Address - Street 1:207 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7077
Practice Address - Country:US
Practice Address - Phone:716-664-8194
Practice Address - Fax:716-664-8418
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000209-1231H00000X
NY14000011100237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000209-1OtherNYS AUDIOLOGIST LICENSE
NY14000011100OtherNYS HEARING AID DISPENSER