Provider Demographics
NPI:1356497986
Name:THOMAS G. TRUDELL, INC.
Entity Type:Organization
Organization Name:THOMAS G. TRUDELL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:TRUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:518-563-5343
Mailing Address - Street 1:79 HAMMOND LN
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2008
Mailing Address - Country:US
Mailing Address - Phone:518-563-5343
Mailing Address - Fax:518-563-5373
Practice Address - Street 1:79 HAMMOND LN
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2008
Practice Address - Country:US
Practice Address - Phone:518-563-5343
Practice Address - Fax:518-563-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02210608Medicaid
NY4036870001Medicare ID - Type Unspecified