1740796739 NPI number — MARINA VAZURA MA, CCC-SLP, TSSLD

Table of content: MARINA VAZURA MA, CCC-SLP, TSSLD (NPI 1740796739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740796739 NPI number — MARINA VAZURA MA, CCC-SLP, TSSLD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZURA
Provider First Name:
MARINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP, TSSLD
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:
1740796739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13812 68TH DR UNIT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11367-1633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-828-3498
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5160 MARATHON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11362-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-423-8138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2017

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 ; 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