Provider Demographics
NPI:1588960652
Name:ADVANCED AUDIOLOGY OF NY PC
Entity type:Organization
Organization Name:ADVANCED AUDIOLOGY OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:SCD
Authorized Official - Phone:914-395-3277
Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2911
Mailing Address - Country:US
Mailing Address - Phone:914-395-3277
Mailing Address - Fax:914-395-3270
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2911
Practice Address - Country:US
Practice Address - Phone:914-395-3277
Practice Address - Fax:914-395-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002140237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty