MEDICARE: SUZANNA GERSHKOVICH M.S. SLP-CCC

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	235Z00000X	Speech-Language Pathologist	023147	NY

General Provider Information

NPI Number	:	1821348459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA GERSHKOVICH M.S. SLP-CCC

Provider Business Mailing Address
First Line	:	201 E 16TH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3706
Country	:	US
Telephone Number	:	347-326-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 BI COUNTY BLVD
Second Line	:	SUITE 114
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3988
Country	:	US
Telephone Number	:	718-264-1640
Fax Number	:

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

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	02/11/2020

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