Healthcare Provider Details

I. General information

NPI: 1750718987
Provider Name (Legal Business Name): DANA DEBARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 GRAND CENTRAL PKWY
JAMAICA NY
11432-5819
US

IV. Provider business mailing address

44 JERUSALEM AVE
LEVITTOWN NY
11756-3730
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-2931
  • Fax:
Mailing address:
  • Phone: 516-395-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number020210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: