MEDICARE: MRS. GEORGINA LOLLY PECORARO 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	013450-1	NY

General Provider Information

NPI Number	:	1417002643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEORGINA LOLLY PECORARO M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	82 OAKLAND MILLS RD
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-8600
Country	:	US
Telephone Number	:	646-236-9099
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2946
Country	:	US
Telephone Number	:	718-815-0768
Fax Number	:	718-815-4098

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/27/2016

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Directions to “ MRS. GEORGINA LOLLY PECORARO M.A., CCC-SLP” Practice Location

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