Healthcare Provider Details

I. General information

NPI: 1801043575
Provider Name (Legal Business Name): ELLEN SERBER ZOMBACK MS CCC-SLP TSHH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 ROBERT DR
NEW ROCHELLE NY
10804-1718
US

IV. Provider business mailing address

89 ROBERT DR
NEW ROCHELLE NY
10804-1718
US

V. Phone/Fax

Practice location:
  • Phone: 914-235-4711
  • Fax: 914-576-4044
Mailing address:
  • Phone: 914-235-4711
  • Fax: 914-576-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number007506-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: