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NPI Code Detail

MEDICARE: MS. KHADEJAR T DIMSON MS,CCC-SLP

MEDICARE: MS. KHADEJAR T DIMSON MS,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
1251C00000XDevelopmentally Disabled Services Day Training Agency015579-1NY
2252Y00000XEarly Intervention Provider Agency015579-1NY

General Provider Information

NPI Number : 1932411790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KHADEJAR T DIMSON MS,CCC-SLP
Provider Business Mailing Address
First Line : 870 LENOX RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2519
Country : US
Telephone Number : 917-297-4287
Fax Number :
Provider Business Practice Location Address
First Line : 512 CARROLL ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-1030
Country : US
Telephone Number : 718-624-5271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2010
Last Update Date : 07/09/2010

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