MEDICARE: COURTNEY PRYOR

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	252Y00000X	Early Intervention Provider Agency	12054464	NY

General Provider Information

NPI Number	:	1922236884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTNEY PRYOR

Provider Business Mailing Address
First Line	:	200 HART BLVD APT 4E
Second Line	:	200 HART BLVD. APT4E
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3460
Country	:	US
Telephone Number	:	718-442-2704
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 HART BLVD APT 4E
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3460
Country	:	US
Telephone Number	:	718-442-2704
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	COURTNEY PRYOR
Credential	:	SLP
Telephone Number	:	718-442-2704

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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