Provider Demographics
NPI:1487802880
Name:RIVERSIDE AUDIOLOGY, LLC
Entity type:Organization
Organization Name:RIVERSIDE AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-341-2026
Mailing Address - Street 1:161 RIVERSIDE DR STE M10
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4112
Mailing Address - Country:US
Mailing Address - Phone:607-770-9012
Mailing Address - Fax:607-797-3879
Practice Address - Street 1:161 RIVERSIDE DR STE M10
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4112
Practice Address - Country:US
Practice Address - Phone:607-770-9012
Practice Address - Fax:607-797-3879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X
NY0001331332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech