=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548307697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANIS DEBRA HASSID M.A. C.C.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2582 EILEEN RD
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11572-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-678-0138
-----------------------------------------------------
Fax | 516-255-0078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2582 EILEEN RD
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11572-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-678-0138
-----------------------------------------------------
Fax | 516-255-0078
-----------------------------------------------------
=====================================================
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 | 002755-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------