1396758314 NPI number — TROY AUDIOLOGY, PC

Table of content: (NPI 1396758314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396758314 NPI number — TROY AUDIOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TROY AUDIOLOGY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEARING ASSESSMENT & REHABILITATION SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396758314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 BURDETT AVE
Provider Second Line Business Mailing Address:
105
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-272-7323
Provider Business Mailing Address Fax Number:
518-272-7243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 BURDETT AVE
Provider Second Line Business Practice Location Address:
105
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-272-7323
Provider Business Practice Location Address Fax Number:
518-272-7243
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUENELLE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
518-943-0591

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  15000010665 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1411 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9659828 . This is a "GHI-HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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