Provider Demographics
NPI:1508928631
Name:SAMUEL, GEORGE (MS, CCC , SLP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MS, CCC , SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 ERIC LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3603
Mailing Address - Country:US
Mailing Address - Phone:516-385-3854
Mailing Address - Fax:
Practice Address - Street 1:1478 ERIC LN
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-3603
Practice Address - Country:US
Practice Address - Phone:516-385-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012697-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist