Provider Demographics
NPI:1225347875
Name:LONG ISLAND UNIVERSITY
Entity Type:Organization
Organization Name:LONG ISLAND UNIVERSITY
Other - Org Name:DOWNTOWN BROOKLYN SPEECH AND HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC
Authorized Official - Phone:718-488-3482
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:METCALFE BUILDING ROOM 257
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5301
Mailing Address - Country:US
Mailing Address - Phone:718-488-3482
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:METCALFE BUILDING ROOM 257
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5301
Practice Address - Country:US
Practice Address - Phone:718-488-3482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1764-1231H00000X
NY002644-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty