Healthcare Provider Details

I. General information

NPI: 1619892197
Provider Name (Legal Business Name): THOMAS O'CONNOR H.I.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WOLF RD
ALBANY NY
12205-5945
US

IV. Provider business mailing address

29 TWICWOOD LN
QUEENSBURY NY
12804-1330
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-4340
  • Fax: 518-438-4340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000084772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: