Healthcare Provider Details

I. General information

NPI: 1083926786
Provider Name (Legal Business Name): CGB SPEECH-LANGUAGE PATHOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 96TH ST SUITE 7D
NEW YORK NY
10025-6526
US

IV. Provider business mailing address

50 W 96TH ST SUITE 7D
NEW YORK NY
10025-6526
US

V. Phone/Fax

Practice location:
  • Phone: 212-222-9520
  • Fax:
Mailing address:
  • Phone: 212-222-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number6503
License Number StateNY

VIII. Authorized Official

Name: MS. CYNTHIA G BRASLAU
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA.,CCC-SLP
Phone: 212-222-9520