Provider Demographics
NPI:1285783340
Name:NORTHTOWN AUDIOLOGY PC
Entity type:Organization
Organization Name:NORTHTOWN AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MESSINEO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD DOCTOR OF AUDIOL
Authorized Official - Phone:716-691-3817
Mailing Address - Street 1:6041 TRANSIT RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051
Mailing Address - Country:US
Mailing Address - Phone:716-691-3817
Mailing Address - Fax:716-691-3548
Practice Address - Street 1:6041 TRANSIT RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051
Practice Address - Country:US
Practice Address - Phone:716-691-3817
Practice Address - Fax:716-691-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001157231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005760672OtherBLUE CROSS BLUE SHIELD
NY9211446OtherINDEPENDENT HEALTH
NY00025858301OtherUNIVERA