Basic Information
| Provider Information | |||||||||
| NPI: | 1639722986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALGANIK | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DUBAVTSOVA | ||||||||
| OtherFirstName: | VICTORIYA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 114 ATLANTIC AVE APT 86 | ||||||||
| Address2: | |||||||||
| City: | LYNBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115633458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474595747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 150-50 14TH ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670091 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2019 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.