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General NPI Number Information
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NPI Number | 1649582560
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Entity Type | Individual
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Provider Name | ALYSE ROSTAS MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 160 TIMBERLINE DR
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City | BRENTWOOD
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State | NY
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Zip | 11717-6209
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Country | US
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Telephone | 516-356-6039
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Fax |
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Provider Business Mailing Address
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Address Line | 160 TIMBERLINE DR
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City | BRENTWOOD
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State | NY
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Zip | 11717-6209
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Country | US
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Telephone | 516-356-6039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 012499
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License Number State | NY
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