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NPI Code Detail

MEDICARE: LI SPEECH THERAPY OF SOUTH SHORE

MEDICARE: LI SPEECH THERAPY OF SOUTH SHORE
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1336757921
Entity Type Code : Organization
Provider Name (Legal Business Name) : LI SPEECH THERAPY OF SOUTH SHORE
Provider Business Mailing Address
First Line : 213 HALLOCK RD STE 6
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-3000
Country : US
Telephone Number : 631-689-6858
Fax Number : 631-751-6027
Provider Business Practice Location Address
First Line : 2915 SUNRISE HWY
Second Line :
City : ISLIP TERRACE
State : NY
Zip : 11752-2716
Country : US
Telephone Number : 631-689-6858
Fax Number :
Authorized Official
Title or Position : SPEECH LANGUAGE PATHOLOIST
Name : JANINE STIENE
Credential : MA CCC-SLP
Telephone Number : 631-689-6858
Provider Enumeration Date : 07/20/2020
Last Update Date : 07/20/2020

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Directions to “LI SPEECH THERAPY OF SOUTH SHORE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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