Healthcare Provider Details

I. General information

NPI: 1568798619
Provider Name (Legal Business Name): SOUTH SHORE SPEECH LANGUAGE AND SWALLOWING DISORDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MONTAUK HWY STE 152
BABYLON NY
11702-3009
US

IV. Provider business mailing address

400 MONTAUK HWY STE 152
BABYLON NY
11702-3009
US

V. Phone/Fax

Practice location:
  • Phone: 631-669-7098
  • Fax: 631-669-3736
Mailing address:
  • Phone: 631-669-7098
  • Fax: 631-669-3736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN M ASOFSKY
Title or Position: MANAGING PARTNER
Credential: M.A.
Phone: 631-669-7098