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General NPI Number Information
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NPI Number | 1184991762
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Entity Type | Organization
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Legal Business Name | GINA SLP PC
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Dates
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Enumeration Date | 11/25/2011
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Last Update Date | 11/25/2011
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Provider Practice Location Address
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Address Line | 329 MCBAINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-4271
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Country | US
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Telephone | 646-824-6466
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Fax | 718-227-0368
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Provider Business Mailing Address
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Address Line | 329 MCBAINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-4271
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Country | US
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Telephone | 646-824-6466
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Fax | 718-227-0368
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Authorized Official
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Title or Position | PRESIDENT
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Name | GINA VEKSELMAN
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Credential | MS, CCC-SLP
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Telephone | 646-824-6466
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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 | 014734
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License Number State | NY
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