Provider Demographics
NPI:1003356106
Name:LEIFSSON, BRYNJAR
Entity Type:Individual
Prefix:
First Name:BRYNJAR
Middle Name:
Last Name:LEIFSSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ALTAMORE ST
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2902
Mailing Address - Country:US
Mailing Address - Phone:631-423-7700
Mailing Address - Fax:
Practice Address - Street 1:26 ALTAMORE ST
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2902
Practice Address - Country:US
Practice Address - Phone:631-423-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3643198235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist