Katelyn Rose Clark

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

14000053702 Issued in NY

Practice address

605 E Main St Unit 19
Bay Shore, NY 11706-8505

Phone

(631) 665-0795

NPI assigned

Mar 24, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Universal Hearing LLC

  dba Miracle Ear

  • Hearing Aid Equipment
  • Bay Shore, NY
  • NPI 1336692276
  NPD (past)

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1831726520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 E MAIN ST UNIT 19",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068505",
            "telephone_number": "631-665-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E MAIN ST UNIT 19",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068505",
            "telephone_number": "631-665-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATELYN",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "NY",
            "license": "14000053702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City Medical of Upper East Side, PLLC (CityMD)
• City Medical of Upper East Side, PLLC (Summit Health)
• Joseph Ciufo
• Heather Lynne Clare, MA, ADHD-CCSP
• Heather Amy Clark, MA
• Rebecca N Clark
• Claudia J Selgrad DO PC
• Hilda Mariette Clesidor-Louis
• Candace Coakley-Assefa
• Kyle Cobb

• Hearing Instrument Specialist in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Hearing Instrument Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.