1790076529 NPI number — MS. ALISHA MARIE CONSTANTINO M.S. CCC SLP

Table of content: MS. ALISHA MARIE CONSTANTINO M.S. CCC SLP (NPI 1790076529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790076529 NPI number — MS. ALISHA MARIE CONSTANTINO M.S. CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONSTANTINO
Provider First Name:
ALISHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOGGO
Provider Other First Name:
ALISHA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790076529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 SAWYER COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E. SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-941-9816
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SAWYER COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E. SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-941-9816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2011

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:  010270-1 , 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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