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General NPI Number Information
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NPI Number | 1780995829
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Entity Type | Organization
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Legal Business Name | TINAGERO SPEECH LANGUAGE PATHOLOGY PC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 23 WHEATLEY AVE
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City | EAST WILLISTON
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State | NY
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Zip | 11596-2544
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Country | US
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Telephone | 516-746-8465
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 512
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City | WILLISTON PARK
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State | NY
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Zip | 11596-0512
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Country | US
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Telephone | 516-746-8465
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MS. ELIZABETH HURLEY TINAGERO
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Credential | MA CCC-SLP
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Telephone | 516-746-8465
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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 | 003270-1
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License Number State | NY
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