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General NPI Number Information
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NPI Number | 1346660529
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Entity Type | Organization
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Legal Business Name | ANASTACIA SPEECH CORP
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Dates
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Enumeration Date | 04/26/2014
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Last Update Date | 04/26/2014
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Provider Practice Location Address
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Address Line | 23205 56TH RD
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2010
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Country | US
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Telephone | 718-279-0594
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Fax | 718-279-0594
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Provider Business Mailing Address
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Address Line | 23205 56TH RD
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2010
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Country | US
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Telephone | 718-279-0594
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Fax | 718-279-0594
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUN SOO PAK
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Credential | MS.ED/CCC-SLP/TSHH
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Telephone | 718-279-0594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 018359-1
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License Number State | NY
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