Provider Demographics
NPI:1366813818
Name:NAGY, EILEEN NANCY (AUD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:NANCY
Last Name:NAGY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:NANCY
Other - Last Name:MATUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:14 COLUMBIA CIRCLE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 COLUMBIA CIRCLE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-690-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002623231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002623OtherAUDIOLOGIST LICENSE