Provider Demographics
NPI:1144496712
Name:BAUMGARTNER, NICOLE E (AUD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:E
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-833-4488
Mailing Address - Fax:716-839-1218
Practice Address - Street 1:4600 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4500
Practice Address - Country:US
Practice Address - Phone:716-833-4488
Practice Address - Fax:716-839-1218
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002152-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400034440Medicare PIN