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General NPI Number Information
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NPI Number | 1114280369
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Entity Type | Organization
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Legal Business Name | DLGG ENTERPRISES
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 60 WILLOW ST
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City | FLORAL PARK
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State | NY
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Zip | 11001-3440
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Country | US
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Telephone | 917-957-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 60 WILLOW ST
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City | FLORAL PARK
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State | NY
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Zip | 11001-3440
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Country | US
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Telephone | 917-957-9797
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DIANA LYNN GAMBINO GADES
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Credential | MA CCC-SLP, PC
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Telephone | 917-957-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 012435
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License Number State | NY
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