Provider Demographics
NPI:1467786087
Name:AGASSI-ROTH, RONIT E
Entity Type:Individual
Prefix:
First Name:RONIT
Middle Name:E
Last Name:AGASSI-ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RONIT
Other - Middle Name:E
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:34 OLYMPIA LN
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2843
Mailing Address - Country:US
Mailing Address - Phone:845-369-3699
Mailing Address - Fax:845-369-3699
Practice Address - Street 1:34 OLYMPIA LN
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2843
Practice Address - Country:US
Practice Address - Phone:845-369-3699
Practice Address - Fax:845-369-3699
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019445-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist