Healthcare Provider Details

I. General information

NPI: 1326114430
Provider Name (Legal Business Name): SYOSSET SPEECH & HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JERICHO TPKE STE 103 SYOSSET SPEECH & HEARING
SYOSSET NY
11791-4501
US

IV. Provider business mailing address

175 JERICHO TPKE STE 103 SYOSSET SPEECH & HEARING
SYOSSET NY
11791-4546
US

V. Phone/Fax

Practice location:
  • Phone: 516-364-1234
  • Fax: 516-364-3132
Mailing address:
  • Phone: 516-364-1234
  • Fax: 516-364-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR PODWALL
Title or Position: DIRECTOR AUD & SPEECH PATHOLOGIST
Credential: PHD
Phone: 516-364-1234