MEDICARE: CONSCIOUSLY CONNECTED CORP

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

General Provider Information

NPI Number	:	1407637556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSCIOUSLY CONNECTED CORP

Provider Business Mailing Address
First Line	:	22421 64TH AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22421 64TH AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2326
Country	:	US
Telephone Number	:	247-259-0763
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARISA TAORMINA
Credential	:
Telephone Number	:	347-259-0763

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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Directions to “CONSCIOUSLY CONNECTED CORP ” 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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