Provider Demographics
NPI:1124238159
Name:SUFFOLK HEARING & SPEECH CENTER
Entity type:Organization
Organization Name:SUFFOLK HEARING & SPEECH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEE-OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LA
Authorized Official - Phone:631-277-6000
Mailing Address - Street 1:369 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2800
Mailing Address - Country:US
Mailing Address - Phone:631-277-6000
Mailing Address - Fax:631-277-6862
Practice Address - Street 1:369 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2800
Practice Address - Country:US
Practice Address - Phone:631-277-6000
Practice Address - Fax:631-277-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245276Medicaid
NY00245276Medicaid