1417279902 NPI number — OPEN LINES SPEECH AND COMMUNICATION PLLC

Table of content: (NPI 1417279902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417279902 NPI number — OPEN LINES SPEECH AND COMMUNICATION PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN LINES SPEECH AND COMMUNICATION 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:
1417279902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 7TH AVE
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-5012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-430-6800
Provider Business Mailing Address Fax Number:
888-807-7794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 7TH AVE.
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-430-6800
Provider Business Practice Location Address Fax Number:
888-807-7794
Provider Enumeration Date:
02/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GALGANO
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
FAY
Authorized Official Title or Position:
OWNER;SPEECHPATHOLOGIST;RESEARCHSCI
Authorized Official Telephone Number:
212-430-6800

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  0142901 , 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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