Provider Demographics
NPI:1679114656
Name:PANCILA, ANDREW EMILE JR (CCC-SLP, CBIS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:EMILE
Last Name:PANCILA
Suffix:JR
Gender:M
Credentials:CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BOND ST APT 3G
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2029
Mailing Address - Country:US
Mailing Address - Phone:516-849-4035
Mailing Address - Fax:
Practice Address - Street 1:21 BOND ST APT 3G
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2029
Practice Address - Country:US
Practice Address - Phone:516-849-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty