Provider Demographics
NPI:1538457197
Name:TREMBLEY, JOHN (MSED)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:TREMBLEY
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GILBERT ST # G
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12816-2643
Mailing Address - Country:US
Mailing Address - Phone:518-677-8255
Mailing Address - Fax:518-677-8250
Practice Address - Street 1:33 GILBERT ST # G
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2643
Practice Address - Country:US
Practice Address - Phone:518-677-8255
Practice Address - Fax:518-677-8250
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist