MEDICARE: CAROL A TESSEL 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	013574	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649423468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A TESSEL CCC-SLP

Provider Business Mailing Address
First Line	:	207 E 37TH ST
Second Line	:	APT 4J
City	:	NEW YORK
State	:	NY
Zip	:	10016-3160
Country	:	US
Telephone Number	:	646-649-3731
Fax Number	:	646-649-3731

Provider Business Practice Location Address
First Line	:	207 E 37TH ST
Second Line	:	APT 4J
City	:	NEW YORK
State	:	NY
Zip	:	10016-3160
Country	:	US
Telephone Number	:	646-649-3731
Fax Number	:	646-649-3731

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

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	10/23/2008

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Directions to “ CAROL A TESSEL CCC-SLP” Practice Location

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