Provider Demographics
NPI:1629221627
Name:DYAL-GARIB, INDIRA GYANESHWARI (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:INDIRA
Middle Name:GYANESHWARI
Last Name:DYAL-GARIB
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1926
Mailing Address - Country:US
Mailing Address - Phone:917-826-6728
Mailing Address - Fax:973-273-0737
Practice Address - Street 1:79 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1926
Practice Address - Country:US
Practice Address - Phone:917-826-6728
Practice Address - Fax:973-273-0737
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013356-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist