1568737054 NPI number — SPEECH OT THERAPY PLLC

Table of content: (NPI 1568737054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568737054 NPI number — SPEECH OT THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH OT THERAPY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568737054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 W FULTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-1933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-327-1757
Provider Business Mailing Address Fax Number:
516-431-1706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 W FULTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-1933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-327-1757
Provider Business Practice Location Address Fax Number:
516-431-1706
Provider Enumeration Date:
03/15/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
I
Authorized Official Title or Position:
MEMBER/MGR
Authorized Official Telephone Number:
718-327-1757

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  014591-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XE0001X , with the licence number: 014591-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XF0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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