Healthcare Provider Details

I. General information

NPI: 1760572465
Provider Name (Legal Business Name): PRADEEP ASOKARATHINAM MS.CCC.SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 COUNTY ROUTE 49
MIDDLETOWN NY
10940-6882
US

IV. Provider business mailing address

496 COUNTY ROUTE 49
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-926-5647
  • Fax:
Mailing address:
  • Phone: 845-926-5647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011573-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: