Healthcare Provider Details

I. General information

NPI: 1467380600
Provider Name (Legal Business Name): LEGENDARY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 STAFFORD AVE
STATEN ISLAND NY
10309-2109
US

IV. Provider business mailing address

90 REDWOOD AVE
STATEN ISLAND NY
10308-1860
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH CAMILLE ADAMITA
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 917-288-6011