Provider Demographics
NPI:1275849218
Name:ORLOV, GINA (MS SLP-CCC TSSLD)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:ORLOV
Suffix:
Gender:F
Credentials:MS SLP-CCC TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 EAGAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4103
Mailing Address - Country:US
Mailing Address - Phone:917-495-7762
Mailing Address - Fax:
Practice Address - Street 1:113 EAGAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4103
Practice Address - Country:US
Practice Address - Phone:917-495-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020309-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist