Healthcare Provider Details

I. General information

NPI: 1174777346
Provider Name (Legal Business Name): MIRIAM JENNIFER ROKACH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 DAUB AVE
HEWLETT NY
11557-1105
US

IV. Provider business mailing address

340 DAUB AVE
HEWLETT NY
11557-1105
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-7617
  • Fax:
Mailing address:
  • Phone: 516-295-7617
  • 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: