Healthcare Provider Details

I. General information

NPI: 1881912251
Provider Name (Legal Business Name): AIM HIGH SPEECH THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 72ND RD APT LL4
FOREST HILLS NY
11375-4670
US

IV. Provider business mailing address

11215 72ND RD APT LL4
FOREST HILLS NY
11375-4670
US

V. Phone/Fax

Practice location:
  • Phone: 718-263-3363
  • Fax:
Mailing address:
  • Phone: 347-558-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016525
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number016525
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number018761
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number016525
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number018761
License Number StateNY

VIII. Authorized Official

Name: MRS. LARISA ZIRKIYEV
Title or Position: CEO
Credential: MA CCC-SLP, TSLD
Phone: 718-263-3363