Provider Demographics
NPI:1790999464
Name:ADVANCED AUDIOLOGY SERVICES PC
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:518-270-5802
Mailing Address - Street 1:2001 5TH AVE
Mailing Address - Street 2:TROY MEDICAL PLAZA
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3340
Mailing Address - Country:US
Mailing Address - Phone:518-270-5802
Mailing Address - Fax:518-270-5807
Practice Address - Street 1:2001 5TH AVE
Practice Address - Street 2:TROY MEDICAL PLAZA
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3340
Practice Address - Country:US
Practice Address - Phone:518-270-5802
Practice Address - Fax:518-270-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000315-1261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP25074Medicare UPIN
AA0760Medicare ID - Type Unspecified