Basic Information
| Provider Information | |||||||||
| NPI: | 1255394284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA-CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140862638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166816722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 56 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140862638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166816722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 10/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 001290-1 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 01384849 | 05 | NY | MEDICAID |