MEDICARE: MADELINE VARGAS M.A.,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	013850-1	NY

General Provider Information

NPI Number	:	1306094370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE VARGAS M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	500 W 175TH ST APT 57
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-8104
Country	:	US
Telephone Number	:	646-220-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W 175TH ST APT 57
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-8104
Country	:	US
Telephone Number	:	646-220-2451
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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