MEDICARE: MRS. LEAH FOGEL 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	015436	NY

General Provider Information

NPI Number	:	1669613295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH FOGEL SLP

Provider Business Mailing Address
First Line	:	1453 EAST 12 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6605
Country	:	US
Telephone Number	:	718-753-4184
Fax Number	:	718-252-2472

Provider Business Practice Location Address
First Line	:	1453 EAST 12 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6605
Country	:	US
Telephone Number	:	718-753-4184
Fax Number	:	718-252-2472

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

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	03/11/2009

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