Provider Demographics
NPI:1740509397
Name:TRI-COUNTY AUDIOLOGY SERVICES, PC
Entity type:Organization
Organization Name:TRI-COUNTY AUDIOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:AXELROD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:845-304-9934
Mailing Address - Street 1:79 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6824
Mailing Address - Country:US
Mailing Address - Phone:845-304-9934
Mailing Address - Fax:845-634-6026
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5704
Practice Address - Country:US
Practice Address - Phone:201-342-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00044500231H00000X
NY000851-1231H00000X
NJMG00753231HA2500X
NY14000006177231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058240Medicare PIN