MEDICARE: MARY GLYPTIS

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	0215721	NY

General Provider Information

NPI Number	:	1780955252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GLYPTIS

Provider Business Mailing Address
First Line	:	956 BAY RIDGE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5834
Country	:	US
Telephone Number	:	347-247-3885
Fax Number	:	718-439-9100

Provider Business Practice Location Address
First Line	:	956 BAY RIDGE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5834
Country	:	US
Telephone Number	:	347-247-3885
Fax Number	:	718-439-9100

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

Provider Enumeration Date	:	01/15/2012
Last Update Date	:	01/15/2012

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Directions to “ MARY GLYPTIS ” Practice Location

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