MEDICARE: LDR INNOVATIVE SPEECH SERVICES P.C.

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	009779-1	NY

General Provider Information

NPI Number	:	1700169349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDR INNOVATIVE SPEECH SERVICES P.C.

Provider Business Mailing Address
First Line	:	314 PINEBROOK RD
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-2624
Country	:	US
Telephone Number	:	917-579-0456
Fax Number	:	732-972-4373

Provider Business Practice Location Address
First Line	:	1373 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3313
Country	:	US
Telephone Number	:	917-579-0456
Fax Number	:	732-972-4373

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. LOUISE D'ONOFRIO-RIAL
Credential	:	M.S., CCC-SLP
Telephone Number	:	732-972-4373

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “LDR INNOVATIVE SPEECH SERVICES P.C. ” Practice Location

Language	Start Address	Practice Location

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