Basic Information
| Provider Information | |||||||||
| NPI: | 1629432778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BSE HEARING,INC. | ||||||||
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| OtherOrganizationName: | LONG ISLAND QUEENS HEARING ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1953 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BALDWIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115102820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168646289 | ||||||||
| FaxNumber: | 6314993062 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 WOODBURY RD | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117971411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554233700 | ||||||||
| FaxNumber: | 6314993062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2016 | ||||||||
| LastUpdateDate: | 04/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | BADER | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5168646289 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 001913 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.