Basic Information
| Provider Information | |||||||||
| NPI: | 1457741209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALIN | ||||||||
| FirstName: | MARISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4848 COMMERCIAL DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134136237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157327528 | ||||||||
| FaxNumber: | 3157327553 | ||||||||
| Practice Location | |||||||||
| Address1: | 4848 COMMERCIAL DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134136237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157327528 | ||||||||
| FaxNumber: | 3157327553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2015 | ||||||||
| LastUpdateDate: | 02/02/2015 | ||||||||
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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 | 237700000X | 14000027041 | NY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 14000027041 | 01 | NY | LICENSE NUMBER | OTHER |