Provider Demographics
NPI:1457506727
Name:BAUM-SIMON, ELAINE GLADYS (MACCCLSP)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:GLADYS
Last Name:BAUM-SIMON
Suffix:
Gender:F
Credentials:MACCCLSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MIDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1608
Mailing Address - Country:US
Mailing Address - Phone:516-857-4477
Mailing Address - Fax:516-374-5673
Practice Address - Street 1:330 MIDWOOD RD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1608
Practice Address - Country:US
Practice Address - Phone:516-857-4477
Practice Address - Fax:516-374-5673
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006716-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist