Basic Information
| Provider Information | |||||||||
| NPI: | 1588276372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ZISSEL | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 852 WESTMINSTER AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSIDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072053051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085310629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150-50 14TH ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670071 | ||||||||
| FaxNumber: | 7187670086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2020 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.