Provider Demographics
NPI:1750355160
Name:METTING, PAMELA J (AUD)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:METTING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ELIZABETH BLACKWELL STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-789-3595
Mailing Address - Fax:315-789-9051
Practice Address - Street 1:64 ELIZABETH BLACKWELL STREET
Practice Address - Street 2:SUITE C
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-789-3595
Practice Address - Fax:315-789-9051
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000202237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR54810Medicare UPIN
NY10639BMedicare PIN