Provider Demographics
NPI:1568697878
Name:CHARCZUK, JULIE A (MS SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CHARCZUK
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GAGENS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-1973
Mailing Address - Country:US
Mailing Address - Phone:631-765-8836
Mailing Address - Fax:631-765-6669
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3048
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist