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General NPI Number Information
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NPI Number | 1114326444
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Entity Type | Organization
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Legal Business Name | EPIC SPEECH THERAPY, PLLC
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 155 BEACH 120TH ST APT 1A
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1900
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Country | US
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Telephone | 917-709-3473
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Fax |
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Provider Business Mailing Address
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Address Line | 155 BEACH 120TH STREET APT 1A
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1900
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Country | US
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Telephone | 917-709-3473
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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. MARIAELENA NOTO
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Credential | M.A., CCC-SLP
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Telephone | 917-709-3473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | NY
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