Healthcare Provider Details

I. General information

NPI: 1225621360
Provider Name (Legal Business Name): ANNIEROSE OBRIEN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 3RD AVE # 11717
BRENTWOOD NY
11717-6198
US

IV. Provider business mailing address

8 FLORENCE PL
CENTER MORICHES NY
11934-3305
US

V. Phone/Fax

Practice location:
  • Phone: 631-434-2583
  • Fax:
Mailing address:
  • Phone: 631-681-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: