Basic Information
| Provider Information | |||||||||
| NPI: | 1780154716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HYDAR | ||||||||
| FirstName: | MEAGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 688 WHITE PLAINS RD # A | ||||||||
| Address2: | |||||||||
| City: | SCARSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105835059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465890342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148488070 | ||||||||
| FaxNumber: | 9146815231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2018 | ||||||||
| LastUpdateDate: | 02/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 002846-1 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | NY | MEDICAID |