Provider Demographics
NPI:1811448228
Name:GREYLOCK AUDIOLOGY LLC
Entity type:Organization
Organization Name:GREYLOCK AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PUTTICK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:413-443-4800
Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5493
Mailing Address - Country:US
Mailing Address - Phone:413-443-4800
Mailing Address - Fax:413-442-9701
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5493
Practice Address - Country:US
Practice Address - Phone:413-443-4800
Practice Address - Fax:413-442-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA784231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119581AMedicaid