Provider Demographics
NPI:1336546746
Name:GOTHAM AUDIOLOGY SOLUTIONS, PC
Entity type:Organization
Organization Name:GOTHAM AUDIOLOGY SOLUTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DULUDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-737-9500
Mailing Address - Street 1:329 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5600
Mailing Address - Country:US
Mailing Address - Phone:212-737-9500
Mailing Address - Fax:212-734-2652
Practice Address - Street 1:329 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5600
Practice Address - Country:US
Practice Address - Phone:212-737-9500
Practice Address - Fax:212-734-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001697-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty