MEDICARE: MRS. LYNDA LEDERER ELBAZ M.S.

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	:	1497067466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNDA LEDERER ELBAZ M.S.

Provider Business Mailing Address
First Line	:	41A RENA LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5267
Country	:	US
Telephone Number	:	732-363-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PARK HILL CIR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3635
Country	:	US
Telephone Number	:	718-720-0090
Fax Number	:

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

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	01/24/2012

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Directions to “ MRS. LYNDA LEDERER ELBAZ M.S.” Practice Location

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