Provider Demographics
NPI:1851412282
Name:NARDELLA, THOMAS GUY (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GUY
Last Name:NARDELLA
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3657
Mailing Address - Country:US
Mailing Address - Phone:315-252-1728
Mailing Address - Fax:315-252-4445
Practice Address - Street 1:13 SOUTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3657
Practice Address - Country:US
Practice Address - Phone:315-252-1728
Practice Address - Fax:315-252-4445
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY150000012327OtherHEARING AID DISPENSER