MEDICARE: MRS. REGINA MIROCHNIK 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	294168091	NY
2	235Z00000X	Speech-Language Pathologist	019776	NY

General Provider Information

NPI Number	:	1265754014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGINA MIROCHNIK M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	48 EXETER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3704
Country	:	US
Telephone Number	:	718-769-2698
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 EXETER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3704
Country	:	US
Telephone Number	:	718-751-5005
Fax Number	:

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

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	02/23/2021

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Directions to “ MRS. REGINA MIROCHNIK M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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