Provider Demographics
NPI:1679717227
Name:LORI GOLDEN MA-CCC, SLP & ROBIN BUMP, PT PLLC
Entity Type:Organization
Organization Name:LORI GOLDEN MA-CCC, SLP & ROBIN BUMP, PT PLLC
Other - Org Name:MAKING MILESTONES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC SLP, TSHH
Authorized Official - Phone:212-249-2588
Mailing Address - Street 1:320 E 65TH ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6743
Mailing Address - Country:US
Mailing Address - Phone:212-249-2588
Mailing Address - Fax:212-249-2594
Practice Address - Street 1:320 E 65TH ST
Practice Address - Street 2:SUITE 117
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6743
Practice Address - Country:US
Practice Address - Phone:212-249-2588
Practice Address - Fax:212-249-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009941-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency