Provider Demographics
NPI:1003101528
Name:DAVIDOV, HAMUTAL
Entity Type:Individual
Prefix:
First Name:HAMUTAL
Middle Name:
Last Name:DAVIDOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14730 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2930
Mailing Address - Country:US
Mailing Address - Phone:347-617-9578
Mailing Address - Fax:
Practice Address - Street 1:14730 73RD AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2930
Practice Address - Country:US
Practice Address - Phone:347-617-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist