Provider Demographics
NPI:1659682516
Name:GROSS-RUBIN, JUDITH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:GROSS-RUBIN
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 1:14442 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1714
Mailing Address - Country:US
Mailing Address - Phone:917-658-6166
Mailing Address - Fax:
Practice Address - Street 1:14442 70TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1714
Practice Address - Country:US
Practice Address - Phone:917-658-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019809OtherLICENSE#