=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821524489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SPEECH & LANGUAGE CENTERS OF EXCELLENCE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2017
-----------------------------------------------------
Last Update Date | 08/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1623 FLATBUSH AVE SUITE 110
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-3259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-387-5350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1623 FLATBUSH AVE SUITE 110
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-3259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-387-5350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. DALIA AVEZBADALOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-885-6558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | 0229941
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------