Provider Demographics
NPI:1063425353
Name:PAGE, KATHLEEN (MA, FAAA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5020
Mailing Address - Country:US
Mailing Address - Phone:631-360-4327
Mailing Address - Fax:631-780-6822
Practice Address - Street 1:732 SMITHTOWN BYP
Practice Address - Street 2:SUITE 301
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5020
Practice Address - Country:US
Practice Address - Phone:631-360-4327
Practice Address - Fax:631-780-6822
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000651231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063425353OtherNPI
1114936291OtherNPI
G100025456OtherMEDICARE PTAN - PRACTICE/HEARS AUDIOLOGY PC (QUEENS-SILVERCREST)
G400025969OtherMEDICARE PTAN - INDIVIDUAL, QUEENS (SILVERCREST)
M7107WA271OtherMEDICARE PTAN - INDIVIDUAL IN GROUP/PRACTICE
NYM74613OtherEMPIRE BLUE CROSS/BLUE SH
WWA271OtherMEDICARE PTAN - PRACTICE/HEARS AUDIOLOGY PC
NYM74613OtherEMPIRE BLUE CROSS/BLUE SH
G100025456OtherMEDICARE PTAN - PRACTICE/HEARS AUDIOLOGY PC (QUEENS-SILVERCREST)
G400025969OtherMEDICARE PTAN - INDIVIDUAL, QUEENS (SILVERCREST)