Provider Demographics
NPI:1073261558
Name:OSCAR LOPEZ TAMAYO SPEECH LANGUAGE PATHOLOGIST PLLC
Entity Type:Organization
Organization Name:OSCAR LOPEZ TAMAYO SPEECH LANGUAGE PATHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-707-5192
Mailing Address - Street 1:27 BARKER AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1559
Mailing Address - Country:US
Mailing Address - Phone:347-707-5192
Mailing Address - Fax:
Practice Address - Street 1:27 BARKER AVE APT 403
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1559
Practice Address - Country:US
Practice Address - Phone:347-707-5192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency