Basic Information
| Provider Information | |||||||||
| NPI: | 1962616136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIG APPLE PROCARE SLP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3205 EMMONS AVE | ||||||||
| Address2: | SUITE 7B | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112351147 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1809 GRAVESEND NECK RD | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112294510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187437090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BELOPOLSKY | ||||||||
| AuthorizedOfficialFirstName: | SVETLANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7187437090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 016710 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.