1508178906 NPI number — MRS. ANA TERESA ROLDAN SLP-CCC

Table of content: MRS. ANA TERESA ROLDAN SLP-CCC (NPI 1508178906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508178906 NPI number — MRS. ANA TERESA ROLDAN SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLDAN
Provider First Name:
ANA
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP-CCC
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:
1508178906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7404 263RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN OAKS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11004-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-347-1175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185-08 UNION TURPIKE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11366-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-264-7250
Provider Business Practice Location Address Fax Number:
718-264-7922
Provider Enumeration Date:
07/14/2010

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:  019199-1 , 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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