1841365467 NPI number — ADIRONDACK AUDIOLOGY ASSOCIATES, PC

Table of content: (NPI 1841365467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841365467 NPI number — ADIRONDACK AUDIOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADIRONDACK AUDIOLOGY ASSOCIATES, 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:
ADIRONDACK AUDIOLOGY ASSOCIATES HEARING AND BALANCE CENTER
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:
1841365467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MARSETT RD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBURNE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05482-7150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-922-9545
Provider Business Mailing Address Fax Number:
802-922-9546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-922-9545
Provider Business Practice Location Address Fax Number:
802-922-9546
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALSH
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER, AUDIOLOGIST
Authorized Official Telephone Number:
802-922-9545

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  15000006649 , 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: GRP490169002 . This is a "BLUE SHIELD NORTHEAST NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: M0338 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00753842 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841365467 . This is a "GROUP NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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