Provider Demographics
NPI:1477690584
Name:TERRONES CAMPOS, JAVIER ALBERTO (SLP)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:ALBERTO
Last Name:TERRONES CAMPOS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2837
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:300 B
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03838T46697OtherINTERNATIONAL BENEFITS ADMINISTRATORS L.L.C.