Basic Information
| Provider Information | |||||||||
| NPI: | 1932521135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PREZIOSO | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 556 MERRICK RD | ||||||||
| Address2: | LL1 | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115705487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165963277 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 556 MERRICK RD | ||||||||
| Address2: | LL1 | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115705487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165963277 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2014 | ||||||||
| LastUpdateDate: | 04/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 14000039663 | NY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 14000039663 | 01 | NY | HEARING AID DISPENSER LICENSE | OTHER |