MEDICARE: SOCIAL ADVENTURES NYC LLC

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

General Provider Information

NPI Number	:	1386108421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCIAL ADVENTURES NYC LLC

Provider Business Mailing Address
First Line	:	160 W 97TH ST APT 4E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-9233
Country	:	US
Telephone Number	:	917-575-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 E 87TH ST APT 30G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-3160
Country	:	US
Telephone Number	:	917-575-2906
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NILI GELDWERT
Credential	:	MA, SLP-CCC
Telephone Number	:	917-575-2906

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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Directions to “SOCIAL ADVENTURES NYC LLC ” Practice Location

Language	Start Address	Practice Location

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