Basic Information
| Provider Information | |||||||||
| NPI: | 1003144411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTER | ||||||||
| FirstName: | GEORGIA | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166816722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 56 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166816722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2009 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 001289-1 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist | 332H00000X | 14000003279 | NY | N | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | 01384849 | 05 | NY | MEDICAID |