Provider Demographics
NPI:1497289078
Name:NAOMI GITTLER SPEECH-LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:NAOMI GITTLER SPEECH-LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP PC TSHH
Authorized Official - Phone:917-650-6927
Mailing Address - Street 1:103 GERALD LANE
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804
Mailing Address - Country:US
Mailing Address - Phone:917-650-6927
Mailing Address - Fax:
Practice Address - Street 1:103 GERALD LN
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1113
Practice Address - Country:US
Practice Address - Phone:917-650-6927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006828-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP1Other1164564225