1538391578 NPI number — SPEECH LANGUAGE PATHOLOGY UNLIMITED, PLLC

Table of content: (NPI 1538391578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538391578 NPI number — SPEECH LANGUAGE PATHOLOGY UNLIMITED, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH LANGUAGE PATHOLOGY UNLIMITED, 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:
1538391578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10960-0788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-523-3796
Provider Business Mailing Address Fax Number:
845-358-2389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46B THIRD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10960-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-523-3796
Provider Business Practice Location Address Fax Number:
845-215-0163
Provider Enumeration Date:
08/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCCABE
Authorized Official First Name:
JILL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-263-2992

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730332982 . This is a "NPI NUMBER" identifier . This identifiers is of the category "OTHER".




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