Healthcare Provider Details

I. General information

NPI: 1013251099
Provider Name (Legal Business Name): WESTBROOK AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4903 JOCKEY ST
BALLSTON SPA NY
12020-2072
US

IV. Provider business mailing address

4903 JOCKEY ST
BALLSTON SPA NY
12020-2072
US

V. Phone/Fax

Practice location:
  • Phone: 518-257-6808
  • Fax:
Mailing address:
  • Phone: 518-257-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000029566
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002028
License Number StateNY

VIII. Authorized Official

Name: DR. JANELLE LANE
Title or Position: OWNER
Credential: AU.D.
Phone: 518-257-6808