Provider Demographics
NPI:1770720062
Name:WOOD, JO ANN (AUDIOLOGIST)
Entity type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARGYLE SQ
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2712
Mailing Address - Country:US
Mailing Address - Phone:631-661-5111
Mailing Address - Fax:631-661-1959
Practice Address - Street 1:20 ARGYLE SQ
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2712
Practice Address - Country:US
Practice Address - Phone:631-661-5111
Practice Address - Fax:631-661-1959
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002241-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300001821OtherMEDICARE PTAN
NY0022411OtherAUDIOLOGIST LICENSE
NY14000027971OtherHEARING AID DISPENSER