Provider Demographics
NPI:1255470373
Name:ADELMAN, JENNIFER SUSAN
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUSAN
Last Name:ADELMAN
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 1:11 HAYRICK LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1403
Mailing Address - Country:US
Mailing Address - Phone:631-486-1239
Mailing Address - Fax:
Practice Address - Street 1:1770 MOTOR PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11749-5260
Practice Address - Country:US
Practice Address - Phone:631-582-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009172-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist