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General NPI Number Information
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NPI Number | 1013284579
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Entity Type | Organization
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Legal Business Name | MARINA TINOVSKY, SLP. PC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 284 GARRETSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1236
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Country | US
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Telephone | 917-687-4740
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Fax |
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Provider Business Mailing Address
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Address Line | 284 GARRETSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARINA TINOVSKY
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Credential | MS. SLP-CCC
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Telephone | 917-687-4740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 013003
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License Number State | NY
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