Healthcare Provider Details

I. General information

NPI: 1982702049
Provider Name (Legal Business Name): ALAN MARC RODIN S.L.P., M.A., C.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BEACH 124TH ST
BELLE HARBOR NY
11694-1840
US

IV. Provider business mailing address

PO BOX 920181
ARVERNE NY
11692-0181
US

V. Phone/Fax

Practice location:
  • Phone: 917-742-4089
  • Fax: 718-474-6655
Mailing address:
  • Phone: 917-742-4089
  • Fax: 718-474-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number005002-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: