Provider Demographics
NPI:1124605779
Name:GARDEN CITY SPEECH LANGUAGE PATHOLOGY PC
Entity Type:Organization
Organization Name:GARDEN CITY SPEECH LANGUAGE PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:516-236-3319
Mailing Address - Street 1:7 1ST PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6101
Mailing Address - Country:US
Mailing Address - Phone:516-236-3319
Mailing Address - Fax:
Practice Address - Street 1:7 1ST PL
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6101
Practice Address - Country:US
Practice Address - Phone:516-236-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency