Provider Demographics
NPI:1710231881
Name:PREMIUM THERAPY SPEECH SERVICES P.C.
Entity Type:Organization
Organization Name:PREMIUM THERAPY SPEECH SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/DIRECTO
Authorized Official - Prefix:MS
Authorized Official - First Name:EKATERINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MELITSOPOULOU
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP, TSSH
Authorized Official - Phone:212-304-0400
Mailing Address - Street 1:5030 BROADWAY
Mailing Address - Street 2:SUITE 809
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1666
Mailing Address - Country:US
Mailing Address - Phone:212-304-0400
Mailing Address - Fax:212-304-0999
Practice Address - Street 1:5030 BROADWAY
Practice Address - Street 2:SUITE 809
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1666
Practice Address - Country:US
Practice Address - Phone:212-304-0400
Practice Address - Fax:212-304-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010394235Z00000X
NY021088235Z00000X
NY021674235Z00000X
NY024761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty