Basic Information
| Provider Information | |||||||||
| NPI: | 1225032287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUENELLE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA,CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406153 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303841876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189430591 | ||||||||
| FaxNumber: | 5189434622 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 WARREN ST. | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188289902 | ||||||||
| FaxNumber: | 5188287419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 01/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 000662-1 | NY | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 000662 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.