1578865515 NPI number — ANDREA GOTTLIEB MS CCC SLP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578865515 NPI number — ANDREA GOTTLIEB MS CCC SLP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREA GOTTLIEB MS CCC SLP INC
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:
1578865515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 ANDREWS AVE
Provider Second Line Business Mailing Address:
APTC206
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33483-7243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-329-7434
Provider Business Mailing Address Fax Number:
561-278-6468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 ANDREWS AVE
Provider Second Line Business Practice Location Address:
APTC206
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33483-7243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-329-7434
Provider Business Practice Location Address Fax Number:
561-278-6468
Provider Enumeration Date:
11/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOTTLIEB
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-329-7434

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA5309 , registered in the state of IL ; 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