Provider Demographics
NPI:1093067704
Name:COMMUNICATION REMEDIATION SPEECH AND LANGUAGE CENTER LLC
Entity Type:Organization
Organization Name:COMMUNICATION REMEDIATION SPEECH AND LANGUAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:631-499-5595
Mailing Address - Street 1:2171 JERICHO TPKE
Mailing Address - Street 2:SUITE #340
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2937
Mailing Address - Country:US
Mailing Address - Phone:631-499-5595
Mailing Address - Fax:631-499-3060
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:SUITE #340
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2937
Practice Address - Country:US
Practice Address - Phone:631-499-5595
Practice Address - Fax:631-499-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007782-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency