=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205749926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IDG SWALLOW AND SPEECH PATHOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2026
-----------------------------------------------------
Last Update Date | 09/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 AVENUE T FL 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-645-7112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 619 AVENUE T FL 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-645-7112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR SLP
-----------------------------------------------------
Name | MS. ILANA DANIELLE GABBAY
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 646-645-7112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------