Basic Information
| Provider Information | |||||||||
| NPI: | 1174599765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ISLAND HEARING & BALANCE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2870 HEMPSTEAD TPKE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167316644 | ||||||||
| FaxNumber: | 5167318746 | ||||||||
| Practice Location | |||||||||
| Address1: | 2870 HEMPSTEAD TPKE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167316644 | ||||||||
| FaxNumber: | 5167318746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | CAPO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 5167316644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 231H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.