Provider Demographics
NPI:1801236476
Name:STATE HEARING AND AUDIOLOGY, PC
Entity type:Organization
Organization Name:STATE HEARING AND AUDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, F/AAA
Authorized Official - Phone:315-508-4327
Mailing Address - Street 1:6609 STATE ROUTE 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3547
Mailing Address - Country:US
Mailing Address - Phone:315-508-4327
Mailing Address - Fax:315-262-0300
Practice Address - Street 1:6609 STATE ROUTE 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3547
Practice Address - Country:US
Practice Address - Phone:315-508-4327
Practice Address - Fax:315-262-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002042-1261QH0700X, 237600000X
NY14000020423332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment