Kostas Neoclis, SC.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

002493 Issued in NY

Practice address

4770 Sunrise Hwy Ste 106
Massapequa Park, NY 11762-2911

Phone

(516) 261-9398

Fax

(516) 261-9399

NPI assigned

Feb 22, 2012

Reactivated

May 22, 2013

Last updated

Nov 13, 2019By the provider in NPPES

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• GN Audiology PLLC

  • Hearing and Speech Clinic/Center
  • Massapequa Park, NY
  • NPI 1366990848
  Authorized official Same address or phone
• Munson Medical Center

  • Psychiatric Hospital Unit
  • Traverse City, MI
  • NPI 1891586103
  NPD (past)

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

{
    "created_epoch": "1329868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1932472941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7247-6822",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191700001",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 SUNRISE HWY STE 106",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117622911",
            "telephone_number": "516-261-9398",
            "fax_number": "516-261-9399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEOCLIS",
        "first_name": "KOSTAS",
        "credential": "SC.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-22",
        "last_updated": "2019-11-13",
        "deactivation_date": "2013-01-11",
        "reactivation_date": "2013-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1601000605",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "002493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03686835",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josie C Mott, MSCCC/SLP
• Mount Sinai Hospital
• Dawn Murray, PTA
• Tara Ann Nash, CCC-SLP
• Olivia Nelson, MSW
• Neurorehabilitation and Neuropsycholical Services P.C.
• Hannah Jacqueline Nicchi, LMSW
• Northland Hearing Center, Inc. (GN Audiology)
• Meghan Rose O'Farrell, PT, DPT
• Jacqueline Ann O'Loughlin, MA, CCC-SLP

• Audiologist in Massapequa Park, NY
• Providers in Massapequa Park, NY by specialty
• Audiologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.