MEDICARE: BUMBLEBEE SPEECH THERAPY, P.C.

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	019776	NY

General Provider Information

NPI Number	:	1275914491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUMBLEBEE SPEECH THERAPY, P.C.

Provider Business Mailing Address
First Line	:	48 EXETER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3704
Country	:	US
Telephone Number	:	718-751-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 EXETER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3704
Country	:	US
Telephone Number	:	718-751-5005
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. REGINA MIROCHNIK
Credential	:	CCC-SLP/TSLD
Telephone Number	:	718-751-5005

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	03/09/2021

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