Healthcare Provider Details

I. General information

NPI: 1841365467
Provider Name (Legal Business Name): ADIRONDACK AUDIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BROADWAY STE 1
SARANAC LAKE NY
12983-1486
US

IV. Provider business mailing address

10 MARSETT RD STE 3
SHELBURNE VT
05482-7150
US

V. Phone/Fax

Practice location:
  • Phone: 518-891-0487
  • Fax: 518-891-6718
Mailing address:
  • Phone: 802-922-9545
  • Fax: 802-922-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number15000006649
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: KEITH P. WALSH
Title or Position: OWNER, AUDIOLOGIST
Credential: AU.D.
Phone: 802-922-9545