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General NPI Number Information
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NPI Number | 1881098879
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Entity Type | Organization
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Legal Business Name | BAYSIDE SPEECH & LANGUAGE PALS, PLLC
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 5847 FRANCIS LEWIS BLVD SUITE 15
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City | BAYSIDE
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State | NY
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Zip | 11364-1698
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Country | US
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Telephone | 347-408-4247
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Fax | 347-408-4398
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Provider Business Mailing Address
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Address Line | 5847 FRANCIS LEWIS BLVD SUITE 15
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City | BAYSIDE
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State | NY
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Zip | 11364-1698
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Country | US
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Telephone | 347-408-4247
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Fax | 347-408-4398
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. LINDSEY PERAL
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Credential | M.A. CCC-SLP
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Telephone | 516-457-3794
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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 | 020714
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License Number State | NY
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