Provider Demographics
NPI:1740426600
Name:PIVOVITSCH, EUNICE MARGOT (SLP-CCC)
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:MARGOT
Last Name:PIVOVITSCH
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:MS
Other - First Name:EUNICE
Other - Middle Name:MARGOT
Other - Last Name:(WOLKIN) PIVOVITSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:173-15 JEWEL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:718-380-4155
Mailing Address - Fax:718-380-7311
Practice Address - Street 1:2 ROOSEVELT AVENUE
Practice Address - Street 2:SUITE 300 COOPER KIDS THERAPY ASSOCIATES
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-496-4460
Practice Address - Fax:516-921-4432
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist