Healthcare Provider Details

I. General information

NPI: 1376686063
Provider Name (Legal Business Name): ADELPHI UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 CAMBRIDGE AVE RM 103
GARDEN CITY NY
11530-4235
US

IV. Provider business mailing address

158 CAMBRIDGE AVE RM 103
GARDEN CITY NY
11530-4235
US

V. Phone/Fax

Practice location:
  • Phone: 516-877-4850
  • Fax: 516-877-4865
Mailing address:
  • Phone: 516-877-4850
  • Fax: 516-877-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY BURTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 516-877-3385