Healthcare Provider Details

I. General information

NPI: 1477707545
Provider Name (Legal Business Name): SOUND SPEECH & LANGUAGE PATHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2008
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 TEMPO RD
NEW CITY NY
10956-1329
US

IV. Provider business mailing address

23 TEMPO RD
NEW CITY NY
10956-1329
US

V. Phone/Fax

Practice location:
  • Phone: 845-639-0464
  • Fax:
Mailing address:
  • Phone: 845-639-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRLEY VARGHESE
Title or Position: PRESIDENT
Credential: M.A. CCC-SLP
Phone: 845-639-0464