=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366776734
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS ARLEEN POWMESAMY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2009
-----------------------------------------------------
Last Update Date | 10/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7164 168TH ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11365-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-591-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6620 WETHEROLE ST APT 6M
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-4636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-275-1533
-----------------------------------------------------
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 | 0008974
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------