=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982030300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN ROCHEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2013
-----------------------------------------------------
Last Update Date | 09/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 CAMPUS DR
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-767-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3476 MAJOR DR W
-----------------------------------------------------
City | WANTAGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11793-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-767-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 011537
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------