MEDICARE: KAREN I PRUZANSKY MA, 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	004863-1	NY

General Provider Information

NPI Number	:	1982971586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN I PRUZANSKY MA, CCC, SLP

Provider Business Mailing Address
First Line	:	1390 SOMERSET GATE
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-2163
Country	:	US
Telephone Number	:	201-928-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2801
Country	:	US
Telephone Number	:	718-409-4227
Fax Number	:

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

Provider Enumeration Date	:	11/27/2011
Last Update Date	:	11/27/2011

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