Provider Demographics
NPI:1164040051
Name:ASTORIA SPEECH AND LANGUAGE P.C.
Entity Type:Organization
Organization Name:ASTORIA SPEECH AND LANGUAGE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:631-901-3769
Mailing Address - Street 1:4702 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1117
Mailing Address - Country:US
Mailing Address - Phone:631-901-3769
Mailing Address - Fax:
Practice Address - Street 1:3708 28TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4248
Practice Address - Country:US
Practice Address - Phone:631-901-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty