MEDICARE: MRS. ENBAR ELIMELEKH MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	016894	NY

General Provider Information

NPI Number	:	1225287063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ENBAR ELIMELEKH MA CCC-SLP

Provider Business Mailing Address
First Line	:	27 MERRYMOUNT ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4809
Country	:	US
Telephone Number	:	718-494-2140
Fax Number	:	718-494-3946

Provider Business Practice Location Address
First Line	:	27 MERRYMOUNT ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4809
Country	:	US
Telephone Number	:	718-494-2140
Fax Number	:	718-494-3946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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