1871648956 NPI number — MRS. CAROLE LINDA KORNSWEIG MA CCC SLP

Table of content: MRS. CAROLE LINDA KORNSWEIG MA CCC SLP (NPI 1871648956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871648956 NPI number — MRS. CAROLE LINDA KORNSWEIG MA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORNSWEIG
Provider First Name:
CAROLE
Provider Middle Name:
LINDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA 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:
GRUNES
Provider Other First Name:
CAROLE
Provider Other Middle Name:
LINDA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871648956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 GEORGIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-1232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-524-0450
Provider Business Mailing Address Fax Number:
516-791-8631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
VALLEY STREAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11580-5495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-524-0450
Provider Business Practice Location Address Fax Number:
516-791-8631
Provider Enumeration Date:
01/25/2007

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:  849 , 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)

  • Identifier: AS1681 . This is a "OXFORD INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000057740501 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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