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General NPI Number Information
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NPI Number | 1376916676
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Entity Type | Organization
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Legal Business Name | LONG BEACH SPEECH LANGUAGE PATHOLOGY
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 270 SHORE RD. APT. 30
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City | LONG BEACH
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State | NY
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Zip | 11561-4263
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Country | US
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Telephone | 516-889-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 270 SHORE RD. APT. 30
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City | LONG BEACH
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State | NY
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Zip | 11561-4263
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Country | US
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Telephone | 516-889-4691
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. D SUSAN GROARK
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Credential | MA
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Telephone | 516-889-4691
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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 | 007 378-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 007 378-1
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License Number State | NY
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