Provider Demographics
NPI:1457668063
Name:NSC SPEECH LANGUAGE PATHOLOGY PC
Entity Type:Organization
Organization Name:NSC SPEECH LANGUAGE PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGIAS-COULIANIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:718-939-0306
Mailing Address - Street 1:2915 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1512
Mailing Address - Country:US
Mailing Address - Phone:718-939-0306
Mailing Address - Fax:
Practice Address - Street 1:2915 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1512
Practice Address - Country:US
Practice Address - Phone:718-939-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009203251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)