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General NPI Number Information
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NPI Number | 1699172544
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Entity Type | Organization
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Legal Business Name | NORTH FORK SPEECH-LANGUAGE PATHOLOGY
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 600 GAGENS LANDING RD
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City | SOUTHOLD
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State | NY
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Zip | 11971-1973
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Country | US
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Telephone | 410-241-5668
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Fax |
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Provider Business Mailing Address
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Address Line | 600 GAGENS LANDING RD
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City | SOUTHOLD
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State | NY
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Zip | 11971-1973
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Country | US
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Telephone | 410-241-5668
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | JULIE CHARCZUK
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Credential | MS, CCC-SLP
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Telephone | 410-241-5668
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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 |
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License Number State |
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