Provider Demographics
NPI:1710226337
Name:JENNY ZIAVRAS SLP PC
Entity Type:Organization
Organization Name:JENNY ZIAVRAS SLP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIAVRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:718-943-6202
Mailing Address - Street 1:2391 BELL BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2000
Mailing Address - Country:US
Mailing Address - Phone:718-943-6202
Mailing Address - Fax:718-943-6204
Practice Address - Street 1:2391 BELL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2000
Practice Address - Country:US
Practice Address - Phone:718-943-6202
Practice Address - Fax:718-943-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015674-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty