Basic Information
| Provider Information | |||||||||
| NPI: | 1154587236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MACCC-A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ASSAF | ||||||||
| OtherFirstName: | MARTHA | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MACCCA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 215 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105350215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452275033 | ||||||||
| FaxNumber: | 8452273503 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 HILL BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | JEFFERSON VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105351502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142457700 | ||||||||
| FaxNumber: | 9142457836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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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 | 000730-1 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.