Provider Demographics
NPI:1275805715
Name:M.L. DWORKIN, SPEECH PATHOLOGIST, P.C.
Entity Type:Organization
Organization Name:M.L. DWORKIN, SPEECH PATHOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST-PRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DWORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC/SLP
Authorized Official - Phone:845-364-6264
Mailing Address - Street 1:28 MOHAWK LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2713
Mailing Address - Country:US
Mailing Address - Phone:845-364-6264
Mailing Address - Fax:845-364-6264
Practice Address - Street 1:28 MOHAWK LN
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2713
Practice Address - Country:US
Practice Address - Phone:845-364-6264
Practice Address - Fax:845-364-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency