Provider Demographics
NPI:1619743390
Name:SMOOTH SPEECH LANGUAGE PATHOLOGY PC
Entity Type:Organization
Organization Name:SMOOTH SPEECH LANGUAGE PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGIROVA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SLP
Authorized Official - Phone:917-601-1690
Mailing Address - Street 1:8635 21ST AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4033
Mailing Address - Country:US
Mailing Address - Phone:917-601-1690
Mailing Address - Fax:
Practice Address - Street 1:1555 DAHILL RD FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3581
Practice Address - Country:US
Practice Address - Phone:917-601-1690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency