Provider Demographics
NPI:1992143929
Name:TACONIC AUDIOLOGY, PLLC
Entity type:Organization
Organization Name:TACONIC AUDIOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:845-765-3475
Mailing Address - Street 1:242 ROSSWAY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7354
Mailing Address - Country:US
Mailing Address - Phone:845-765-3475
Mailing Address - Fax:914-337-0541
Practice Address - Street 1:2510 ROUTE 44
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8040
Practice Address - Country:US
Practice Address - Phone:845-765-3475
Practice Address - Fax:914-337-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001627261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech