Provider Demographics
NPI:1669518452
Name:AUDIOLOGICAL DIAGNOSTICS, P.C.
Entity type:Organization
Organization Name:AUDIOLOGICAL DIAGNOSTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:SCD, CCC-A
Authorized Official - Phone:718-745-2826
Mailing Address - Street 1:447 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3205
Mailing Address - Country:US
Mailing Address - Phone:718-745-2826
Mailing Address - Fax:718-745-0040
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000002425237600000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37077OtherGHI HMO
NY5977349OtherAETNA
NY147447OtherPREFERRED CARE
NYM0830POtherHIP
NY000423458104OtherHEALTH PLUS
NY161820OtherELDERPLAN
NY0079201OtherGHI
NY0079201OtherGHI