Provider Demographics
NPI:1306033725
Name:DR. ANDREA F. BLAU SPEECH PATHOLOGIST PLLC
Entity Type:Organization
Organization Name:DR. ANDREA F. BLAU SPEECH PATHOLOGIST PLLC
Other - Org Name:DR. ANDREA F. BLAU & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BLAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-605-0423
Mailing Address - Street 1:575 MADISON AVE
Mailing Address - Street 2:SUITE 1006
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2511
Mailing Address - Country:US
Mailing Address - Phone:212-605-0423
Mailing Address - Fax:212-605-0247
Practice Address - Street 1:575 MADISON AVE
Practice Address - Street 2:SUITE 1006
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2511
Practice Address - Country:US
Practice Address - Phone:212-605-0423
Practice Address - Fax:212-605-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY889251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services