Provider Demographics
NPI:1326285685
Name:ITZKOVITZ, TOVA JILL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TOVA
Middle Name:JILL
Last Name:ITZKOVITZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1339
Mailing Address - Country:US
Mailing Address - Phone:516-443-2126
Mailing Address - Fax:
Practice Address - Street 1:10828 68TH DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2951
Practice Address - Country:US
Practice Address - Phone:516-443-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014098-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist