Provider Demographics
NPI:1518215532
Name:LOGOPEDICA LLC
Entity Type:Organization
Organization Name:LOGOPEDICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERACLEOUS-KYPRIANOU
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:201-564-7635
Mailing Address - Street 1:135 ROCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2113
Mailing Address - Country:US
Mailing Address - Phone:201-564-7635
Mailing Address - Fax:
Practice Address - Street 1:353 FORT WASHINGTON AVE
Practice Address - Street 2:1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6701
Practice Address - Country:US
Practice Address - Phone:212-928-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0163641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty