1205973468 NPI number — MRS. LAUREN AYN SCALISE M.S., CCC-SLP

Table of content: MS. EVA MARIE BANHAM RIOLO SLP (NPI 1710123948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205973468 NPI number — MRS. LAUREN AYN SCALISE M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCALISE
Provider First Name:
LAUREN
Provider Middle Name:
AYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205973468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6430 77TH PL
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
MIDDLE VILLAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11379-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-690-3874
Provider Business Mailing Address Fax Number:
718-416-3171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6430 77TH PL
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
MIDDLE VILLAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11379-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-690-3874
Provider Business Practice Location Address Fax Number:
718-416-3171
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  012788 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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