1164560025 NPI number — MS. LEAH GILLGANNON RUSSO M.A., CCC-SLP

Table of content: MR. STEVEN ROBERT HILL CRNA (NPI 1295880649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164560025 NPI number — MS. LEAH GILLGANNON RUSSO M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSO
Provider First Name:
LEAH
Provider Middle Name:
GILLGANNON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., 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:
GILLGANNON
Provider Other First Name:
LEAH
Provider Other Middle Name:
THERESE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164560025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 WILLIAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHPAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11714-4407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-455-7686
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 WILLIAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-455-7686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2007

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:  012538-1 , 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)





Copyright © 2007-2025 www.npivalidator.com