Provider Demographics
NPI:1528351293
Name:DIMARCO, JENNIFER LYNN (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:771 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3346
Mailing Address - Country:US
Mailing Address - Phone:631-673-5820
Mailing Address - Fax:631-673-5825
Practice Address - Street 1:771 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3346
Practice Address - Country:US
Practice Address - Phone:631-673-5820
Practice Address - Fax:631-673-5825
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237600000X
NY002347231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14000031354OtherHEARING AID DISPENSER TRAINEE