Provider Demographics
NPI:1588007942
Name:ARIZ P FUENTEZ, SPEECH-LANGUAGE PATHOLOGIST, PC
Entity type:Organization
Organization Name:ARIZ P FUENTEZ, SPEECH-LANGUAGE PATHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / SLP
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIZ
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FUENTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:631-439-0595
Mailing Address - Street 1:66 SCOTCHPINE DR
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1605
Mailing Address - Country:US
Mailing Address - Phone:631-439-0595
Mailing Address - Fax:
Practice Address - Street 1:66 SCOTCHPINE DR
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1605
Practice Address - Country:US
Practice Address - Phone:631-439-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019561-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency