Healthcare Provider Details

I. General information

NPI: 1396758314
Provider Name (Legal Business Name): TROY AUDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BURDETT AVE 105
TROY NY
12180-2451
US

IV. Provider business mailing address

2200 BURDETT AVE 105
TROY NY
12180-2451
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-7323
  • Fax: 518-272-7243
Mailing address:
  • Phone: 518-272-7323
  • Fax: 518-272-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number15000010665
License Number StateNY

VIII. Authorized Official

Name: MR. CHRISTOPHER PAUL QUENELLE
Title or Position: CEO
Credential: MA, CCC
Phone: 518-943-0591