Provider Demographics
NPI:1093908154
Name:SPOSATO, CHRISTINE ANNE (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:SPOSATO
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:MARSALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9A EAST MORICHES BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1440
Mailing Address - Country:US
Mailing Address - Phone:631-566-0045
Mailing Address - Fax:
Practice Address - Street 1:9A EAST MORICHES BOULEVARD
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1440
Practice Address - Country:US
Practice Address - Phone:631-566-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03662631Medicaid