Basic Information
| Provider Information | |||||||||
| NPI: | 1508979931 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TROY AUDIOLOGY, PC | ||||||||
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| OtherOrganizationName: | HEARING ASSESSMENT & REHABILITATION SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 JEFFERSON HTS | ||||||||
| Address2: | D001 | ||||||||
| City: | CATSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124141237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189430591 | ||||||||
| FaxNumber: | 5189434622 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 WARREN ST | ||||||||
| Address2: | 2 | ||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125343016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188289902 | ||||||||
| FaxNumber: | 5188287419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | QUENELLE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5189430591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MS, CCC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 15000001937 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | 15000001949 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 1411 | 01 | NY | CDPHP | OTHER | 9659828 | 01 | NY | GHI-HMO | OTHER |