Basic Information
| Provider Information | |||||||||
| NPI: | 1710058102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PHD, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15050 14TH RD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113572609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670091 | ||||||||
| FaxNumber: | 7157670086 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 MINEOLA BLVD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115014064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166634600 | ||||||||
| FaxNumber: | 5166638297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 006416 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.