Provider Demographics
NPI:1376847723
Name:GRADMAN, ALIZA BAILA (MS)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:BAILA
Last Name:GRADMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:BAILA
Other - Last Name:BARENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1312 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3612
Mailing Address - Country:US
Mailing Address - Phone:718-686-3700
Mailing Address - Fax:
Practice Address - Street 1:1312 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3612
Practice Address - Country:US
Practice Address - Phone:718-686-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist