Provider Demographics
NPI:1073669610
Name:HERSHKOWITZ, MICHELLE R (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:HERSHKOWITZ
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 REDLEAF LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5508
Mailing Address - Country:US
Mailing Address - Phone:631-235-5532
Mailing Address - Fax:
Practice Address - Street 1:5 REDLEAF LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5508
Practice Address - Country:US
Practice Address - Phone:631-235-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002194-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist