Provider Demographics
NPI:1346561636
Name:OBERNDORFER, ADRIENNE M
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:M
Last Name:OBERNDORFER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ADRIENNE
Other - Middle Name:M
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3402
Mailing Address - Country:US
Mailing Address - Phone:212-769-3488
Mailing Address - Fax:
Practice Address - Street 1:15 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3402
Practice Address - Country:US
Practice Address - Phone:212-769-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist