Healthcare Provider Details

I. General information

NPI: 1871663757
Provider Name (Legal Business Name): COMPREHENSIVE SPEECH THERAPY SERVICES OF LONG ISLAND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ELM ST SUITE 10
HUNTINGTON NY
11743-3403
US

IV. Provider business mailing address

44 ELM ST SUITE 10
HUNTINGTON NY
11743-3403
US

V. Phone/Fax

Practice location:
  • Phone: 631-425-0656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016577
License Number StateNY

VIII. Authorized Official

Name: MISS MELISSA POLATSCHEK
Title or Position: CO-DIRECTOR
Credential: MA, CCC-SLP
Phone: 631-425-0656