Provider Demographics
NPI:1124604384
Name:MARINA VAZURA SPEECH & LANGUAGE CORP.
Entity Type:Organization
Organization Name:MARINA VAZURA SPEECH & LANGUAGE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZURA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, TSSLD
Authorized Official - Phone:347-828-3498
Mailing Address - Street 1:22030 STRONGHURST AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2007
Mailing Address - Country:US
Mailing Address - Phone:347-828-3498
Mailing Address - Fax:
Practice Address - Street 1:22030 STRONGHURST AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2007
Practice Address - Country:US
Practice Address - Phone:347-828-3498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty