Provider Demographics
NPI:1841365467
Name:ADIRONDACK AUDIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:ADIRONDACK AUDIOLOGY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:802-922-9545
Mailing Address - Street 1:10 MARSETT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7150
Mailing Address - Country:US
Mailing Address - Phone:802-922-9545
Mailing Address - Fax:802-922-9546
Practice Address - Street 1:144 BROADWAY STE 1
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1486
Practice Address - Country:US
Practice Address - Phone:518-891-0487
Practice Address - Fax:518-891-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X, 332S00000X
NY15000006649231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00753842Medicaid
NYGRP490169002OtherBLUE SHIELD NORTHEAST NY
NY1841365467OtherGROUP NPI
NYM0338OtherEMPIRE BLUE CROSS BLUE SH