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General NPI Number Information
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NPI Number | 1467689208
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Entity Type | Organization
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Legal Business Name | NORTHEAST SPEECH-LANGUAGE PATHOLOGY, P.C.
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 580 PEARSE RD
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City | NISKAYUNA
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State | NY
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Zip | 12309-2906
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Country | US
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Telephone | 518-369-6299
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Fax | 518-867-3069
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Provider Business Mailing Address
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Address Line | 1976 CENTRAL AVE
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City | ALBANY
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State | NY
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Zip | 12205-4503
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Country | US
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Telephone | 518-369-6299
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Fax | 518-867-3069
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARINA KRISTEL
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Credential | MS, CCC/SLP
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Telephone | 518-369-6299
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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 | 006099-1
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License Number State | NY
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