Provider Demographics
NPI:1417244526
Name:MARINA'S SPEECH ISLAND SLP, PC
Entity Type:Organization
Organization Name:MARINA'S SPEECH ISLAND SLP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELILOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:917-306-3347
Mailing Address - Street 1:550 DONGAN HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3337
Mailing Address - Country:US
Mailing Address - Phone:917-306-3347
Mailing Address - Fax:718-667-3349
Practice Address - Street 1:550 DONGAN HILLS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3337
Practice Address - Country:US
Practice Address - Phone:917-306-3347
Practice Address - Fax:718-667-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016938252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency