Healthcare Provider Details

I. General information

NPI: 1760629422
Provider Name (Legal Business Name): JANE LAMURA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20429 ROCKAWAY POINT BLVD
ROCKAWAY PT NY
11697-1130
US

IV. Provider business mailing address

20429 ROCKAWAY POINT BLVD
ROCKAWAY PT NY
11697-1130
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-2358
  • Fax:
Mailing address:
  • Phone: 718-634-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number008189-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: