MEDICARE: MRS. MALKA SCHONBRUN SPEECH PATHOLOGIST

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	0017841	NY

General Provider Information

NPI Number	:	1740596386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALKA SCHONBRUN SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	8451 BEVERLY RD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2123
Country	:	US
Telephone Number	:	718-847-5681
Fax Number	:	718-441-1866

Provider Business Practice Location Address
First Line	:	8451 BEVERLY RD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2123
Country	:	US
Telephone Number	:	917-968-4059
Fax Number	:	718-441-1866

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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