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General NPI Number Information
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NPI Number | 1497072219
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Entity Type | Organization
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Legal Business Name | EASTERN SUFFOLK SPEECH AND LANGUAGE PATHOLOGY PC
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 4 MONTAUK HWY
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City | WESTHAMPTON
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State | NY
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Zip | 11977-1235
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Country | US
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Telephone | 631-998-0368
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Fax | 631-878-1722
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Provider Business Mailing Address
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Address Line | 4 MONTAUK HWY
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City | WESTHAMPTON
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State | NY
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Zip | 11977-1235
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Country | US
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Telephone | 631-998-0368
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Fax | 631-878-1722
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. THERESA BLANGIFORTI
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Credential | M.S. CCC-SLP
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Telephone | 631-998-0368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 008637-1
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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 | 008637-1
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License Number State | NY
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