Basic Information
| Provider Information | |||||||||
| NPI: | 1861707838 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAGE AUDIOLOGY AND HEARING AID SERVICES, PLLC | ||||||||
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| OtherOrganizationName: | VILLAGE AUDIOLOGY AND HEARING AID SERVICES | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140862638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166816722 | ||||||||
| FaxNumber: | 7166812091 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 CHURCH ST. | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166816722 | ||||||||
| FaxNumber: | 7166812091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2010 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARTER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7166816722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MA-CCCA AUDIOLOGIST | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 001290-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 332S00000X | 15000006170 | NY | Y | Suppliers | Hearing Aid Equipment |
No ID Information.