Provider Demographics
NPI:1467629212
Name:SCHMITZ, BETH A
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ZAVRA ST
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1713
Mailing Address - Country:US
Mailing Address - Phone:631-244-9383
Mailing Address - Fax:
Practice Address - Street 1:1227 MONTAUK HWY
Practice Address - Street 2:2
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1434
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011647-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist