Healthcare Provider Details

I. General information

NPI: 1376165472
Provider Name (Legal Business Name): INGRID GOCIU CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PIRMASENSER STRASSE 36
KAISERSLAUTERN RHEINLAND-PFALZ
67655
DE

IV. Provider business mailing address

3413 34TH ST APT 1A
ASTORIA NY
11106-1251
US

V. Phone/Fax

Practice location:
  • Phone: 347-531-2566
  • Fax:
Mailing address:
  • Phone: 347-531-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number029035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: