Provider Demographics
NPI:1437693694
Name:BARUCH, ELANA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:BARUCH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ELANA
Other - Middle Name:
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:900 ADEE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3998
Mailing Address - Country:US
Mailing Address - Phone:718-882-8865
Mailing Address - Fax:
Practice Address - Street 1:900 ADEE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3998
Practice Address - Country:US
Practice Address - Phone:718-882-8865
Practice Address - Fax:718-882-8870
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026120-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist