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General NPI Number Information
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NPI Number | 1013251099
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Entity Type | Organization
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Legal Business Name | WESTBROOK AUDIOLOGY
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 4903 JOCKEY ST
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City | BALLSTON SPA
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State | NY
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Zip | 12020-2072
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Country | US
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Telephone | 518-257-6808
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Fax |
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Provider Business Mailing Address
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Address Line | 4903 JOCKEY ST
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City | BALLSTON SPA
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State | NY
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Zip | 12020-2072
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Country | US
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Telephone | 518-257-6808
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANELLE LANE
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Credential | AU.D.
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Telephone | 518-257-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 14000029566
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 002028
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License Number State | NY
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