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General NPI Number Information
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NPI Number | 1083926786
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Entity Type | Organization
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Legal Business Name | CGB SPEECH-LANGUAGE PATHOLOGY SERVICES
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 50 W 96TH ST SUITE 7D
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City | NEW YORK
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State | NY
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Zip | 10025-6526
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Country | US
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Telephone | 212-222-9520
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Fax |
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Provider Business Mailing Address
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Address Line | 50 W 96TH ST SUITE 7D
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City | NEW YORK
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State | NY
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Zip | 10025-6526
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Country | US
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Telephone | 212-222-9520
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. CYNTHIA G BRASLAU
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Credential | MA.,CCC-SLP
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Telephone | 212-222-9520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 6503
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License Number State | NY
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