MEDICARE: ELA GDALYAHU 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649575010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELA GDALYAHU CCC-SLP

Provider Business Mailing Address
First Line	:	19 E 103RD ST FL 4
Second Line	:	PS964 - C/O ELA GDALYAHU
City	:	NEW YORK
State	:	NY
Zip	:	10029-5206
Country	:	US
Telephone Number	:	917-370-3936
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E 103RD ST FL 4
Second Line	:	PS964 - C/O ELA GDALYAHU
City	:	NEW YORK
State	:	NY
Zip	:	10029-5206
Country	:	US
Telephone Number	:	917-370-3936
Fax Number	:

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

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	12/09/2016

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Directions to “ ELA GDALYAHU CCC-SLP” Practice Location

Language	Start Address	Practice Location

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