Provider Demographics
NPI:1063663862
Name:VIRGINIA P. BEAULAC, INC.
Entity Type:Organization
Organization Name:VIRGINIA P. BEAULAC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:BEAULAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-279-9389
Mailing Address - Street 1:115 HAMPTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-279-9389
Mailing Address - Fax:516-280-6327
Practice Address - Street 1:115 HAMPTON ROAD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-279-9389
Practice Address - Fax:516-280-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010-835-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
010-835-1OtherNY STATE LIC# SPEECH-LANGUAGE PATHOLOGY