Healthcare Provider Details

I. General information

NPI: 1609882307
Provider Name (Legal Business Name): PATRICIA O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 JERUSALEM AVE
N BELLMORE NY
11710-1822
US

IV. Provider business mailing address

25112 61ST AVE
LITTLE NECK NY
11362-2429
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number00004363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: