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General NPI Number Information
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NPI Number | 1245603026
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE PT SLP PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 8415 BEVERLY RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-2103
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Country | US
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Telephone | 718-213-3041
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 BEVERLY RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-2103
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Country | US
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Telephone | 718-213-3041
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LEONID YAKUBOV
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Credential | OT
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Telephone | 718-213-3041
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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 |
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License Number State | NY
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