1508173295 NPI number — MRS. MYRNA TAHHAN SPEECH PATHOLAGIST

Table of content: MRS. MYRNA TAHHAN SPEECH PATHOLAGIST (NPI 1508173295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508173295 NPI number — MRS. MYRNA TAHHAN SPEECH PATHOLAGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAHHAN
Provider First Name:
MYRNA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SPEECH PATHOLAGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAHHAN
Provider Other First Name:
MYRNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508173295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 ASKINS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801-1030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-654-1593
Provider Business Mailing Address Fax Number:
347-297-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 ASKINS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-654-1593
Provider Business Practice Location Address Fax Number:
347-297-2551
Provider Enumeration Date:
09/02/2010

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:  0171-59-1 , 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)





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