Provider Demographics
NPI:1326360165
Name:ADLER, JEFFREY (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5314
Mailing Address - Country:US
Mailing Address - Phone:718-377-5305
Mailing Address - Fax:
Practice Address - Street 1:1315 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5314
Practice Address - Country:US
Practice Address - Phone:718-377-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist