MEDICARE: LIANNE DOCTOR

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

General Provider Information

NPI Number	:	1245979681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNE DOCTOR

Provider Business Mailing Address
First Line	:	57 BRAND DR
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-4528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 CHAMBERS ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1222
Country	:	US
Telephone Number	:	212-374-0800
Fax Number	:

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	02/21/2024

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Directions to “ LIANNE DOCTOR ” Practice Location

Language	Start Address	Practice Location

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