Provider Demographics
NPI:1366034225
Name:GREENE-KAUFMAN, SADIE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:GREENE-KAUFMAN
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 ROUTE 17M STE 9
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5233
Mailing Address - Country:US
Mailing Address - Phone:845-294-4787
Mailing Address - Fax:
Practice Address - Street 1:1997 ROUTE 17M STE 9
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5233
Practice Address - Country:US
Practice Address - Phone:845-294-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031651235Z00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program