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Individual

IDA WISE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AU.D.

Contact information

Practice address
95 BRADHURST AVE, VALHALLA, NY 10595-1637
(914) 592-7138
Mailing address
39 TAMARACK DR, CORTLANDT MANOR, NY 10567-6722
(914) 737-2491

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
824-1
NY
231HA2400X
Assistive Technology Practitioner Audiologist
824-1
NY
231HA2500X
Assistive Technology Supplier Audiologist
824-1
NY
237600000X
Audiologist-Hearing Aid Fitter
14000011914
NY

Other

Enumeration date
09/04/2008
Last updated
09/04/2008
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