Provider Demographics
NPI:1083926786
Name:CGB SPEECH-LANGUAGE PATHOLOGY SERVICES
Entity Type:Organization
Organization Name:CGB SPEECH-LANGUAGE PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRASLAU
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:212-222-9520
Mailing Address - Street 1:50 W 96TH ST
Mailing Address - Street 2:SUITE 7D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6526
Mailing Address - Country:US
Mailing Address - Phone:212-222-9520
Mailing Address - Fax:
Practice Address - Street 1:50 W 96TH ST
Practice Address - Street 2:SUITE 7D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6526
Practice Address - Country:US
Practice Address - Phone:212-222-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6503283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00062851OtherASHA-AMERICAN SPEECH-LANGUAGE ASSOCIATION: CERTIFIED MEMBER
NY6503OtherREGISTRATION/CERTIFICATE