Provider Demographics
NPI:1336237007
Name:HEARING & SPEECH CENTER OF WNY
Entity Type:Organization
Organization Name:HEARING & SPEECH CENTER OF WNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MSED SLP
Authorized Official - Phone:716-833-4884
Mailing Address - Street 1:2545 SHERIDAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9478
Mailing Address - Country:US
Mailing Address - Phone:716-833-4884
Mailing Address - Fax:716-833-4881
Practice Address - Street 1:2545 SHERIDAN DRIVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9478
Practice Address - Country:US
Practice Address - Phone:716-833-4884
Practice Address - Fax:716-833-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011175701OtherUNIVERA
NY00011175701OtherUNIVERA
AA0604Medicare ID - Type Unspecified