MEDICARE: MS. SAMANTHA MICHELLE ISANBERG M.S., 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	017542	NY

General Provider Information

NPI Number	:	1255585808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA MICHELLE ISANBERG M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	247 E 28TH ST
Second Line	:	14 H
City	:	NEW YORK
State	:	NY
Zip	:	10016-8508
Country	:	US
Telephone Number	:	914-263-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 95TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7404
Country	:	US
Telephone Number	:	718-680-9751
Fax Number	:

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

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/11/2008

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