Provider Demographics
NPI:1619498144
Name:LENTZERES, EFTHEMIA (SLP)
Entity Type:Individual
Prefix:
First Name:EFTHEMIA
Middle Name:
Last Name:LENTZERES
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 1:8 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 WEST 72ND ST
Practice Address - Street 2:ST #5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3300
Practice Address - Country:US
Practice Address - Phone:631-273-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist