MEDICARE: FATEMAH GULAMHUSSEIN S.L.P.

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	020812	NY

General Provider Information

NPI Number	:	1558651505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATEMAH GULAMHUSSEIN S.L.P.

Provider Business Mailing Address
First Line	:	5800 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3702
Country	:	US
Telephone Number	:	718-630-6180
Fax Number	:	718-630-7437

Provider Business Practice Location Address
First Line	:	230 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3712
Country	:	US
Telephone Number	:	718-439-5600
Fax Number	:	718-439-5633

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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