Healthcare Provider Details

I. General information

NPI: 1477956860
Provider Name (Legal Business Name): ELEANORE OPHALS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELEANORE ANN OPHALS

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 HARVEST LN
COMMACK NY
11725-1508
US

IV. Provider business mailing address

28 HARVEST LN
COMMACK NY
11725-1508
US

V. Phone/Fax

Practice location:
  • Phone: 631-235-3561
  • Fax:
Mailing address:
  • Phone: 631-235-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number025934-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: