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General NPI Number Information
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NPI Number | 1962557348
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Entity Type | Organization
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Legal Business Name | BUCKLEY-JOHNSON PEDIATRICTHERAPIES SLP, PC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 117 HARBOR LN
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-4057
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Country | US
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Telephone | 516-798-2880
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Fax | 516-798-2887
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Provider Business Mailing Address
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Address Line | 117 HARBOR LN
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-4057
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Country | US
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Telephone | 516-798-2880
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Fax | 516-798-2887
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Authorized Official
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Title or Position | CO-OWNER
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Name | MINDY BITTERMAN BUCKLEY
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Credential | MA, CCC-SLP
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Telephone | 516-798-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | TF1774150
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License Number State | NY
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