Healthcare Provider Details

I. General information

NPI: 1124130463
Provider Name (Legal Business Name): CAPITAL AREA SPEECH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 BROADWAY
MENANDS NY
12204-2708
US

IV. Provider business mailing address

339 BROADWAY
MENANDS NY
12204-2708
US

V. Phone/Fax

Practice location:
  • Phone: 518-462-6222
  • Fax: 518-462-6003
Mailing address:
  • Phone: 518-462-6222
  • Fax: 518-462-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD B CORCORAN
Title or Position: EXTENSION
Credential:
Phone: 518-462-6222