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General NPI Number Information
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NPI Number | 1225282692
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Entity Type | Organization
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Legal Business Name | RUSSO SPEECH PATHOLOGY SERVICES, INC.
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 3400 MELVIN PL
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City | SEAFORD
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State | NY
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Zip | 11783-2918
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Country | US
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Telephone | 516-785-2509
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Fax | 516-785-2509
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Provider Business Mailing Address
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Address Line | 3400 MELVIN PL
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City | SEAFORD
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State | NY
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Zip | 11783-2918
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Country | US
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Telephone | 516-785-2509
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Fax | 516-785-2509
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | MRS. ANGELA L RUSSO
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Credential | M.A., CCCSLP
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Telephone | 516-785-2509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 0098791
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License Number State | NY
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