Provider Demographics
NPI:1942314273
Name:TOBACK, FRIEDA (MA CCC A)
Entity type:Individual
Prefix:
First Name:FRIEDA
Middle Name:
Last Name:TOBACK
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:
Other - First Name:FRIEDA
Other - Middle Name:
Other - Last Name:CELNIKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 FIESTA CT
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-289-3997
Mailing Address - Fax:
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:MCGUIRES HEARING AID SERVICE
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-758-3709
Practice Address - Fax:631-758-3731
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00000614231H00000X
NY1439000003966231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000614Medicaid
S18173Medicare UPIN
NY00000614Medicaid