Provider Demographics
NPI:1568468486
Name:THAYER, NOEL T (AUDIOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:NOEL
Middle Name:T
Last Name:THAYER
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:MISS
Other - First Name:NOEL
Other - Middle Name:T
Other - Last Name:STASKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:1 STONE PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3426
Mailing Address - Country:US
Mailing Address - Phone:914-337-0018
Mailing Address - Fax:914-337-0541
Practice Address - Street 1:1 STONE PL
Practice Address - Street 2:STE 203
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3430
Practice Address - Country:US
Practice Address - Phone:914-337-0018
Practice Address - Fax:914-337-0541
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001627231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ09387Medicare UPIN
NYM73131Medicare ID - Type Unspecified