Provider Demographics
NPI:1386033538
Name:MODI, ANJALI
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 98TH ST
Mailing Address - Street 2:4E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1426
Mailing Address - Country:US
Mailing Address - Phone:646-725-5800
Mailing Address - Fax:
Practice Address - Street 1:134 W 26TH ST
Practice Address - Street 2:SUITE 602
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6803
Practice Address - Country:US
Practice Address - Phone:212-604-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist