Provider Demographics
NPI:1184028045
Name:EZRATTY, SYDNEY B
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:B
Last Name:EZRATTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 HOLLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5421
Mailing Address - Country:US
Mailing Address - Phone:516-884-6774
Mailing Address - Fax:
Practice Address - Street 1:2105 HOLLAND WAY
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5421
Practice Address - Country:US
Practice Address - Phone:516-884-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist