Provider Demographics
NPI:1679149595
Name:NATHALIA FONSECA SLP P.C.
Entity Type:Organization
Organization Name:NATHALIA FONSECA SLP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHALIA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-449-9465
Mailing Address - Street 1:19 AITKEN AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2601
Mailing Address - Country:US
Mailing Address - Phone:347-449-9465
Mailing Address - Fax:347-778-0726
Practice Address - Street 1:7716 AUSTIN ST APT 1G
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6919
Practice Address - Country:US
Practice Address - Phone:347-449-9465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech