Healthcare Provider Details

I. General information

NPI: 1215200431
Provider Name (Legal Business Name): JUSTIN D FRANKS SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2012
Last Update Date: 07/30/2026
Certification Date:
Deactivation Date: 10/11/2023
Reactivation Date: 07/30/2026

III. Provider practice location address

101 E PARK AVE 921
LONG BEACH NY
11561-6655
US

IV. Provider business mailing address

101 E PARK AVE 921
LONG BEACH NY
11561-6655
US

V. Phone/Fax

Practice location:
  • Phone: 212-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: