Provider Demographics
NPI:1366621617
Name:J WALIGORA AUDIOLOGY PC
Entity type:Organization
Organization Name:J WALIGORA AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALIGORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-463-1724
Mailing Address - Street 1:6700 KIRKVILLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-463-1724
Mailing Address - Fax:315-463-4020
Practice Address - Street 1:6700 KIRKVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-463-1724
Practice Address - Fax:315-463-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000093-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1708Medicare UPIN