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General NPI Number Information
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NPI Number | 1346517943
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Entity Type | Organization
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Legal Business Name | EARLY STRIDES SLP, PC
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Dates
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Enumeration Date | 11/27/2011
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Last Update Date | 11/27/2011
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Provider Practice Location Address
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Address Line | 3438 BAYFIELD BLVD
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City | OCEANSIDE
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State | NY
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Zip | 11572-4624
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Country | US
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Telephone | 516-318-9832
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Fax |
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Provider Business Mailing Address
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Address Line | 3438 BAYFIELD BLVD
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City | OCEANSIDE
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State | NY
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Zip | 11572-4624
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Country | US
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Telephone | 516-318-9832
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARINA GROSMAN
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Credential | MS, CCC-SLP
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Telephone | 516-665-9002
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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 | 097802198
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License Number State | NY
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