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General NPI Number Information
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NPI Number | 1831466531
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Entity Type | Individual
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Provider Name | TINA MARIE BOLGER M.A., CCC - SLP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 11 CLOVE LAKE PL
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2712
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Country | US
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Telephone | 718-981-8800
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Fax | 718-815-4677
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Provider Business Mailing Address
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Address Line | 10 KIMBERLY CT
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City | MANALAPAN
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State | NJ
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Zip | 07726-4600
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Country | US
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Telephone | 718-981-8800
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Fax | 718-815-4677
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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 | 012388
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License Number State | NY
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