Provider Demographics
NPI:1376565697
Name:SCHAEFFLER, JUDY J (MS AUDIOLOGY)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:J
Last Name:SCHAEFFLER
Suffix:
Gender:F
Credentials:MS AUDIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 MOUNT ZOAR RD
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:NY
Mailing Address - Zip Code:14871-9545
Mailing Address - Country:US
Mailing Address - Phone:607-734-2104
Mailing Address - Fax:607-733-9558
Practice Address - Street 1:1554 MOUNT ZOAR RD
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:NY
Practice Address - Zip Code:14871-9545
Practice Address - Country:US
Practice Address - Phone:607-734-2104
Practice Address - Fax:607-733-9558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000208-1231H00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP98312Medicare UPIN