MEDICARE: SVETLANA ATENZON

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	021086	NY

General Provider Information

NPI Number	:	1891079943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA ATENZON

Provider Business Mailing Address
First Line	:	TELEMEDICINE SERVICES
Second Line	:	1040 WEST FINGERBOARD RD
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 MAMARONECK AVE STE 204
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-1839
Country	:	US
Telephone Number	:	914-421-8272
Fax Number	:

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	11/20/2020

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Directions to “ SVETLANA ATENZON ” Practice Location

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