Healthcare Provider Details

I. General information

NPI: 1538206107
Provider Name (Legal Business Name): INNA OGANESIAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROTTKAMP PL
OLD BETHPAGE NY
11804-1021
US

IV. Provider business mailing address

5 ROTTKAMP PL
OLD BETHPAGE NY
11804-1021
US

V. Phone/Fax

Practice location:
  • Phone: 516-713-7098
  • Fax:
Mailing address:
  • Phone: 516-713-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011972-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: