MEDICARE: MR. FRANK LORUSSO JR. MS, CCC,SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	007110-1	NY

General Provider Information

NPI Number	:	1114163904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK LORUSSO JR. MS, CCC,SLP

Provider Business Mailing Address
First Line	:	3451 86TH ST
Second Line	:	JACKSON HEIGHTS
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3350
Country	:	US
Telephone Number	:	917-842-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	5804 17TH AVE
Second Line	:	BROOKLYN
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2141
Country	:	US
Telephone Number	:	917-842-1025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2008
Last Update Date	:	12/28/2008

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Directions to “ MR. FRANK LORUSSO JR. MS, CCC,SLP” Practice Location

Language	Start Address	Practice Location

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