Provider Demographics
NPI:1578644001
Name:SPIVAK, LYNN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:G
Last Name:SPIVAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E NECK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1567
Mailing Address - Country:US
Mailing Address - Phone:718-470-8912
Mailing Address - Fax:718-470-1679
Practice Address - Street 1:430 LAKEVILLE RD.
Practice Address - Street 2:HEARING & SPEECH
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:718-470-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist