Provider Demographics
NPI:1477234326
Name:SAGALOV, YAN (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:YAN
Middle Name:
Last Name:SAGALOV
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 OCEAN PKWY APT 6D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8442
Mailing Address - Country:US
Mailing Address - Phone:646-379-2703
Mailing Address - Fax:
Practice Address - Street 1:1600 ROCKAWAY PKWY RM 128
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4318
Practice Address - Country:US
Practice Address - Phone:646-379-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist