Healthcare Provider Details

I. General information

NPI: 1720725328
Provider Name (Legal Business Name): CHARLENE MARIE GREGORY H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLENE MARIE TROST

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAM'S CLUB HEARING AID CENTER, 3735 UNION RD.
CHEEKTOWAGA NY
14225
US

IV. Provider business mailing address

121 MAIN ST.
ONEIDA NY
13421
US

V. Phone/Fax

Practice location:
  • Phone: 716-685-2015
  • Fax:
Mailing address:
  • Phone: 315-363-7869
  • Fax: 315-363-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000068067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: