Individual provider Active NPI

Courtney Ann Roth

  • Audiologist
  • Hicksville, NY
National Provider Identifier
1073178729
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Practice address
73A E Old Country Rd
Hicksville, NY 11801-4200
Phone
(516) 520-8736
Fax
(516) 433-4840
NPI assigned
May 8, 2019
Last updated
May 8, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU Primary

Addresses

Primary practice location

73A E Old Country Rd
Hicksville, NY 11801-4200

Mailing address

8 Elderwood LN
Melville, NY 11747-1512
Phone (631) 935-5388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200220002176 NY Practitioner - Qualified Audiologist 9931536562 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002882NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Distribution, LLC CurrentSince Nov 10, 2021 Accepting new patients

Locations

355 Broadway
Amityville, NY 11701
Phone (631) 229-3100

355 Broadway
Ste 4
Amityville, NY 11701
Phone (631) 789-1794

73 E Old Country Rd
#A
Hicksville, NY 11801
Phone (516) 520-8736

1776 Broadway
New York, NY 10019
Phone (212) 399-7329

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1073178729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 ELDERWOOD LN",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117471512",
            "telephone_number": "631-935-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73A E OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014200",
            "telephone_number": "516-520-8736",
            "fax_number": "516-433-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "COURTNEY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.