Provider Demographics
NPI:1336448380
Name:STATEN ISLAND AUDIOLOGY AND HEARING PC
Entity Type:Organization
Organization Name:STATEN ISLAND AUDIOLOGY AND HEARING PC
Other - Org Name:STATEN ISLAND HEARIG & BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:718-816-1952
Mailing Address - Street 1:78 TODT HILL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4513
Mailing Address - Country:US
Mailing Address - Phone:718-816-1952
Mailing Address - Fax:718-816-5118
Practice Address - Street 1:78 TODT HILL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4513
Practice Address - Country:US
Practice Address - Phone:718-816-1952
Practice Address - Fax:718-816-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001287-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty