MEDICARE: DZHULAY- BOZO SPEECH THERAPY, P.C.

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1407138688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DZHULAY- BOZO SPEECH THERAPY, P.C.

Provider Business Mailing Address
First Line	:	2643 E 24TH ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2643 E 24TH ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2609
Country	:	US
Telephone Number	:	347-878-0848
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YELENA DZHULAY-BOZO
Credential	:
Telephone Number	:	347-878-0848

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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