MEDICARE: DR. MAX RYAN FREEMAN PHD, 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	146.015120	IL
2	235Z00000X	Speech-Language Pathologist	029160-01	NY

General Provider Information

NPI Number	:	1245860584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAX RYAN FREEMAN PHD, CCC-SLP

Provider Business Mailing Address
First Line	:	2719 44TH DR APT 20B
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 44TH DR
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3034
Country	:	US
Telephone Number	:	914-610-0871
Fax Number	:

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

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	01/24/2020

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Directions to “ DR. MAX RYAN FREEMAN PHD, CCC-SLP” Practice Location

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