Provider Demographics
NPI:1902090384
Name:ROME HEARING CLINIC
Entity Type:Organization
Organization Name:ROME HEARING CLINIC
Other - Org Name:ROME HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:MIDDLEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-A
Authorized Official - Phone:315-336-7250
Mailing Address - Street 1:624 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4326
Mailing Address - Country:US
Mailing Address - Phone:315-336-7250
Mailing Address - Fax:315-336-7254
Practice Address - Street 1:624 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4326
Practice Address - Country:US
Practice Address - Phone:315-336-7250
Practice Address - Fax:315-336-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY784237600000X
NY984237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01164089Medicaid
NY01140050Medicaid
NY01164089Medicaid