Healthcare Provider Details

I. General information

NPI: 1013284579
Provider Name (Legal Business Name): MARINA TINOVSKY, SLP. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 GARRETSON AVE
STATEN ISLAND NY
10305-1236
US

IV. Provider business mailing address

284 GARRETSON AVE
STATEN ISLAND NY
10305-1236
US

V. Phone/Fax

Practice location:
  • Phone: 917-687-4740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number013003
License Number StateNY

VIII. Authorized Official

Name: MARINA TINOVSKY
Title or Position: PRESIDENT
Credential: MS. SLP-CCC
Phone: 917-687-4740