Provider Demographics
NPI:1083974976
Name:BIANCO, ELLEN BETH (MS)
Entity Type:Individual
Prefix:MS
First Name:ELLEN BETH
Middle Name:
Last Name:BIANCO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 POND FIELD CT
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1300
Mailing Address - Country:US
Mailing Address - Phone:631-659-3284
Mailing Address - Fax:516-627-8484
Practice Address - Street 1:4 POND FIELD CT
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1300
Practice Address - Country:US
Practice Address - Phone:631-659-3284
Practice Address - Fax:516-627-8484
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist