MEDICARE: LAURA MARIE PRIMIS MS CCC-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	014236	NY

General Provider Information

NPI Number	:	1851545032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE PRIMIS MS CCC-SLP

Provider Business Mailing Address
First Line	:	4821 5TH ST
Second Line	:	APT 2I
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5694
Country	:	US
Telephone Number	:	917-670-0941
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 5TH ST APT 2I
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5695
Country	:	US
Telephone Number	:	917-670-0941
Fax Number	:

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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