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General NPI Number Information
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NPI Number | 1750936753
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Entity Type | Organization
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Legal Business Name | EDA-MAE MINTO-BROOKS SLP PLLC
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 513 LOWELL ST
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City | WESTBURY
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State | NY
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Zip | 11590-4422
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Country | US
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Telephone | 516-860-9472
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Fax |
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Provider Business Mailing Address
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Address Line | 513 LOWELL ST
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City | WESTBURY
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State | NY
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Zip | 11590-4422
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Country | US
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Telephone | 516-860-9472
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. EDA-MAE MINTO-BROOKS
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Credential | SLP
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Telephone | 516-860-9472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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