MEDICARE: MS. ELINA GORODETSKY 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	021490	NY

General Provider Information

NPI Number	:	1942506084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELINA GORODETSKY SLP

Provider Business Mailing Address
First Line	:	71 VILLAGE RD N
Second Line	:	APT. 2C
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4706
Country	:	US
Telephone Number	:	718-974-4213
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 VILLAGE RD N
Second Line	:	APT. 2C
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4706
Country	:	US
Telephone Number	:	718-974-4213
Fax Number	:

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

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	09/28/2012

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