Basic Information
| Provider Information | |||||||||
| NPI: | 1093399677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROOSEVELT FIELD HEARING CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 585 STEWART AVE STE LL26 | ||||||||
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| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115304739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162288730 | ||||||||
| FaxNumber: | 5162288730 | ||||||||
| Practice Location | |||||||||
| Address1: | 585 STEWART AVE STE LL26 | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115304739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162288730 | ||||||||
| FaxNumber: | 5162288728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2021 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | MATYKO | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | MORRISSEY | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5162288730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | AUD | ||||||||
| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.