Provider Demographics
NPI:1568646073
Name:GINZBURG, FANYA (SLP)
Entity Type:Individual
Prefix:
First Name:FANYA
Middle Name:
Last Name:GINZBURG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6010
Mailing Address - Country:US
Mailing Address - Phone:917-400-2292
Mailing Address - Fax:347-702-6522
Practice Address - Street 1:424 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6010
Practice Address - Country:US
Practice Address - Phone:917-400-2292
Practice Address - Fax:347-702-6522
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist