MEDICARE: MISS PEARL LEDEREICH 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	:	1689952392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PEARL LEDEREICH M.S.

Provider Business Mailing Address
First Line	:	1471 59TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5037
Country	:	US
Telephone Number	:	718-436-2404
Fax Number	:	718-851-4530

Provider Business Practice Location Address
First Line	:	1471 59TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5037
Country	:	US
Telephone Number	:	718-436-2404
Fax Number	:

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

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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Directions to “ MISS PEARL LEDEREICH M.S.” Practice Location

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