Basic Information
| Provider Information | |||||||||
| NPI: | 1700293495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRONG MEMORIAL HOSPITAL AUDIOLOGY DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2365 CLINTON AVE S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | 5857581297 | ||||||||
| Practice Location | |||||||||
| Address1: | 2365 CLINTON AVE S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | 5857581297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | BEERS | ||||||||
| AuthorizedOfficialFirstName: | CLAIRE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5857585700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | AUD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | 002494 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
ID Information
| ID | Type | State | Issuer | Description | 1346285657 | 05 | NY | MEDICAID |