Provider Demographics
NPI:1003198300
Name:ADLER, ROBIN LISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LISA
Last Name:ADLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E 79TH ST
Mailing Address - Street 2:16C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0709
Mailing Address - Country:US
Mailing Address - Phone:212-570-4695
Mailing Address - Fax:
Practice Address - Street 1:505 E 79TH ST
Practice Address - Street 2:16C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0709
Practice Address - Country:US
Practice Address - Phone:212-570-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002947Medicaid