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NPI Code Detail

MEDICARE: SAMANTHA ELETZ MS, CCC-SLP

MEDICARE: SAMANTHA ELETZ 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
1235Z00000XSpeech-Language Pathologist017520-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1017520OTHERNYSPEECH LICENSE NUMBER

General Provider Information

NPI Number : 1891021648
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ELETZ MS, CCC-SLP
Provider Business Mailing Address
First Line : 512 CARROLL ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-1030
Country : US
Telephone Number : 215-740-6113
Fax Number :
Provider Business Practice Location Address
First Line : 512 CARROLL ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-1030
Country : US
Telephone Number : 215-740-6113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2009
Last Update Date : 11/29/2016

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