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NPI Code Detail

MEDICARE: NINA TARLEV CCC SLP

MEDICARE: NINA TARLEV 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
1235Z00000XSpeech-Language Pathologist0276811NY

General Provider Information

NPI Number : 1457826323
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA TARLEV CCC SLP
Provider Business Mailing Address
First Line : 4699 CEDARVALE RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13215-8649
Country : US
Telephone Number : 315-744-0105
Fax Number :
Provider Business Practice Location Address
First Line : 5075 W SENECA TPKE
Second Line :
City : SYRACUSE
State : NY
Zip : 13215-3216
Country : US
Telephone Number : 315-449-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2018
Last Update Date : 10/08/2018

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