Provider Demographics
NPI:1508979931
Name:TROY AUDIOLOGY, PC
Entity Type:Organization
Organization Name:TROY AUDIOLOGY, PC
Other - Org Name:HEARING ASSESSMENT & REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:QUENELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:518-943-0591
Mailing Address - Street 1:159 JEFFERSON HTS
Mailing Address - Street 2:D001
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1237
Mailing Address - Country:US
Mailing Address - Phone:518-943-0591
Mailing Address - Fax:518-943-4622
Practice Address - Street 1:751 WARREN ST
Practice Address - Street 2:2
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3016
Practice Address - Country:US
Practice Address - Phone:518-828-9902
Practice Address - Fax:518-828-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000001937237600000X
NY15000001949237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1411OtherCDPHP
NY9659828OtherGHI-HMO
NY9659828OtherGHI-HMO