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General NPI Number Information
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NPI Number | 1225347875
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Entity Type | Organization
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Legal Business Name | LONG ISLAND UNIVERSITY
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY PLZ METCALFE BUILDING ROOM 257
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City | BROOKLYN
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State | NY
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Zip | 11201-5301
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Country | US
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Telephone | 718-488-3482
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Fax |
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Provider Business Mailing Address
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Address Line | 1 UNIVERSITY PLZ METCALFE BUILDING ROOM 257
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City | BROOKLYN
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State | NY
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Zip | 11201-5301
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Country | US
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Telephone | 718-488-3482
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MS. JERI W BLUM
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Credential | M.S.CCC
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Telephone | 718-488-3482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1764-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 002644-1
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License Number State | NY
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