Maria Theresa Middleby, MS CCCA NY STATE LIC

Primary specialty

Assistive Technology Supplier AudiologistTaxonomy code 231HA2500X

License

14000005549 Issued in NY

Practice address

624 Black River Blvd
Rome, NY 13440-4326

Phone

(315) 336-7250

Fax

(315) 336-7254

NPI assigned

Feb 9, 2007

Last updated

Mar 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Maria Theresa Leonbruno Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Rome Hearing Clinic

  • Audiologist-Hearing Aid Fitter
  • Rome, NY
  • NPI 1902090384
  NPD (past) Authorized official

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1619018876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 BLACK RIVER BLVD",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134404326",
            "telephone_number": "315-336-7250",
            "fax_number": "315-336-7254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 BLACK RIVER BLVD",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134404326",
            "telephone_number": "315-336-7250",
            "fax_number": "315-336-7254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDLEBY",
        "first_name": "MARIA",
        "middle_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "MS CCCA NY STATE LIC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231HA2500X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "NY",
            "license": "14000005549",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "000784",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01140050",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "LEONBRUNO",
            "middle_name": "THERESA",
            "prefix": "MISS",
            "credential": "MS CCCA NY STATE LIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ananadavalli Menon, M.D.
• Madalyn Merkt, LMSW
• Lauren Messenger-Harris, MS, CCC-SLP
• Michael I Levi Medical PLLC
• Michael Tan MD PC
• Allen Migliaccio, CRNA
• Christina Lyndell Miller, PA-C
• Kelly Miller
• Mark James Miller, LMSW
• Myron H Miller, LCSW

• Audiologist in Rome, NY
• Providers in Rome, NY by specialty
• Audiologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.