Provider Demographics
NPI:1164667150
Name:ODESSKY, PHILIP JAY
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JAY
Last Name:ODESSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 WESTINGHOUSE RD
Mailing Address - Street 2:SUITE 542
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8196
Mailing Address - Country:US
Mailing Address - Phone:607-271-9783
Mailing Address - Fax:607-795-1300
Practice Address - Street 1:2898 WESTINGHOUSE RD
Practice Address - Street 2:SUITE 542
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8196
Practice Address - Country:US
Practice Address - Phone:607-271-9783
Practice Address - Fax:607-795-1300
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000004650237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist