NPIMap

Organization Active NPI

Staten Island Audiological Services, P.C.

  • Audiologist
  • Staten Island, NY
National Provider Identifier
1922380971
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
000603 Issued in NY
Legal business name
STATEN ISLAND AUDIOLOGICAL SERVICES, P.C.
Practice address
1173 Forest Ave
Staten Island, NY 10310-2408
Phone
(718) 981-6020
Fax
(718) 876-8370
NPI assigned
Sep 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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

Authorized official

Name
Dr. Mary E Goodacre, AUD, CCC-ANPI 1467538553
Title
President
Phone
(718) 981-6020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193400000X SINGLE SPECIALTY GROUP 231H00000X 000603 NY Primary

Addresses

Primary practice location

1173 Forest Ave
Staten Island, NY 10310-2408

Mailing address

1173 Forest Ave
Staten Island, NY 10310-2408
Phone (718) 981-6020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110927000167 NY Part B Supplier - Clinic/Group Practice 6800067612 Receives reassigned benefits from 2 practitioners
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Locations

1173 Forest Ave
Staten Island, NY 10310
Phone (718) 981-6020

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1922380971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1173 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102408",
            "telephone_number": "718-981-6020",
            "fax_number": "718-876-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1173 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102408",
            "telephone_number": "718-981-6020",
            "fax_number": "718-876-8370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND AUDIOLOGICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-15",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "GOODACRE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-981-6020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AUD, CCC-A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Audiologist",
            "state": "NY",
            "license": "000603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.