1700169349 NPI number — LDR INNOVATIVE SPEECH SERVICES P.C.

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 1700169349 NPI number — LDR INNOVATIVE SPEECH SERVICES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LDR INNOVATIVE SPEECH SERVICES P.C.
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:
1700169349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 PINEBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANALAPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-2624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-579-0456
Provider Business Mailing Address Fax Number:
732-972-4373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1373 86TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11228-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-579-0456
Provider Business Practice Location Address Fax Number:
732-972-4373
Provider Enumeration Date:
09/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
D'ONOFRIO-RIAL
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
732-972-4373

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  009779-1 , 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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