Provider Demographics
NPI:1417242579
Name:BIANA GERSHKOVICH SLP PC
Entity Type:Organization
Organization Name:BIANA GERSHKOVICH SLP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP/TSSLD
Authorized Official - Phone:917-470-1060
Mailing Address - Street 1:3692 BEDFORD AVENUE
Mailing Address - Street 2:3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:917-470-1060
Mailing Address - Fax:
Practice Address - Street 1:3692 BEDFORD AVENUE
Practice Address - Street 2:3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:917-470-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020159302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization