Healthcare Provider Details

I. General information

NPI: 1316932932
Provider Name (Legal Business Name): ERIN M WALBORN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EMPIRE DR SUITE 204
RENSSELAER NY
12144-5730
US

IV. Provider business mailing address

2 EMPIRE DR SUITE 204
RENSSELAER NY
12144-5730
US

V. Phone/Fax

Practice location:
  • Phone: 518-283-6111
  • Fax: 518-283-6161
Mailing address:
  • Phone: 518-283-6111
  • Fax: 518-283-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001566-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001566-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: