Basic Information
| Provider Information | |||||||||
| NPI: | 1740771815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | IVY | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | AU.D, CCC-A, FAAA, F | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2870 HEMPSTEAD TPKE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167318600 | ||||||||
| FaxNumber: | 5167318746 | ||||||||
| Practice Location | |||||||||
| Address1: | 2870 HEMPSTEAD TPKE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167318600 | ||||||||
| FaxNumber: | 5167318746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 14000035529 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.