=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265871883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOVA CHAYA LEIBOWITZ M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2013
-----------------------------------------------------
Last Update Date | 06/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7515 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-5437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14735 76TH AVE APT 1D
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-374-1241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 58 022475
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------