Provider Demographics
NPI:1376851154
Name:GANTZ, SHOSHANA (MS)
Entity Type:Individual
Prefix:MISS
First Name:SHOSHANA
Middle Name:
Last Name:GANTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4603
Mailing Address - Country:US
Mailing Address - Phone:347-678-9898
Mailing Address - Fax:718-633-1274
Practice Address - Street 1:526 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4603
Practice Address - Country:US
Practice Address - Phone:347-678-9898
Practice Address - Fax:718-633-1274
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist