=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538457312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH SETON PEDIATRIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2011
-----------------------------------------------------
Last Update Date | 07/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 AVENUE OF THE AMERICAS
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-459-3419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 EVERGREEN AVE
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-376-2294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MS. MARIA DOLORES FINLEY
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 516-376-2294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3140N1450X
-----------------------------------------------------
Taxonomy Name | Pediatric Skilled Nursing Facility
-----------------------------------------------------
License Number | 0190221
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------