Basic Information
| Provider Information | |||||||||
| NPI: | 1073825790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPEECH LANGUAGE PATHOLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 PLAZA W | ||||||||
| Address2: | NEW YORK MEDICAL COLLEGE | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145944912 | ||||||||
| FaxNumber: | 9145944853 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 PLAZA W | ||||||||
| Address2: | NEW YORK MEDICAL COLLEGE | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145944912 | ||||||||
| FaxNumber: | 9145944853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2010 | ||||||||
| LastUpdateDate: | 07/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
| AuthorizedOfficialMiddleName: | COLBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9145944821 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.