Provider Demographics
NPI:1306842281
Name:THATER, PATRICIA MARTUCCI (AUD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARTUCCI
Last Name:THATER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MARTUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:35 JOSEPH CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-5042
Mailing Address - Country:US
Mailing Address - Phone:914-565-6550
Mailing Address - Fax:
Practice Address - Street 1:1940 COMMERCE ST STE 109
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4447
Practice Address - Country:US
Practice Address - Phone:914-685-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001958-1231H00000X, 231HA2500X, 231HA2400X
NY14000017989237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM74961Medicare ID - Type Unspecified