Healthcare Provider Details

I. General information

NPI: 1376834127
Provider Name (Legal Business Name): MILA GRUSHIN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 HUGUENOT AVE
STATEN ISLAND NY
10312-1101
US

IV. Provider business mailing address

7 NORTH DR
LIVINGSTON NJ
07039-3508
US

V. Phone/Fax

Practice location:
  • Phone: 718-701-6343
  • Fax:
Mailing address:
  • Phone: 646-602-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number020186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: